Referral Specialist- CMH Care Coordination
Job DescriptionJOB SUMMARY:
Manage all facets of the patient referral process. The scope of the referral process begins with receipt from the provider through to the communication with the patient. Responsibilities include, but are not limited to, obtaining pre-certification or prior-authorizations, scheduling the visit with specialist or outpatient services, completion of documentation with the electronic medical record (EMR) and communicating referral information to referring offices and to the patient.
EDUCATIONAL REQUIREMENTS H.S. Diploma/GED in or equivalent.
CERTIFICATION & LICENSURE REQUIREMENTS Driver's License when driving any vehicle for work-related reasons upon hire.
EXPERIENCE REQUIREMENTS 2-3 years previous experience in medical field
Basic knowledge of medical terminology, anatomy and physiology.
Use of usual and customary equipment used to perform essential functions of the position
SKILLS AND KNOWLEDGE
- Strong telephone and organizational skills and ability to interact effectively with internal/external customers.
- Writes, reads, comprehends, and speaks fluent English.
- Multicultural sensitivity.
- Microsoft Office - basic computer skills.
- Customer/patient focused.
- Critical thinking skills using independent judgment in making decisions.
- Ability to work as a team member.
- Ability to understand and apply guidelines, policies and procedures.
Coordination of Patient Appointments & Authorizations
- Coordinates appointments and relays authorization information to scheduling staff of specialist or outpatient service offices as requested.
- Completes appropriate forms or requisitions needed for referrals or testing, including appropriate CPT/ICD-10 coding.
- Provides appropriate and timely documentation in the patient's EMR using standardized workflows and processes.
- Builds and maintains positive working relationships with all contacts* Acts as a liaison between Carle Health and all referral sources
Correspondence with Patients
- Notifies patient of appointment details via telephone, MyChart, and letter.
- Ensure patients are informed of scheduled tests/procedures. * Reinforces instructions and explanations of tests/procedures to patients per protocol.
- Utilizes exemplary customer service skills with every patient interaction
Obtain Pre-Certifications and Prior Authorizations
- Obtains insurance pre-certifications and prior authorizations for office procedures, diagnostic testing, and imaging for patients.
- Coordinates pre-certs and authorization processes with scheduling staff so appointments can be made in a timely manner.
- Obtains all pertinent clinic health information from provider, clinical staff and/or EMR to process authorizations, referrals, and pre-certifications.
- Verifies demographic information, including insurance, when scheduling and/or obtaining pre-certifications.
- Monitors outstanding authorization requests and initiates follow-up of outstanding authorizations in a timely manner.
- Maintains current knowledge of payer specific requirements of prior authorizations by attending virtual workshops, researching, reading newsletters.