BASIC FUNCTION
Responsible for processing and coordinating patient referrals as an active participant of the patient care team. The RC manages the referral process for patients to specialty care services including navigation to service as appropriate.
PRIMARY RESPONSIBILITIES AND DUTIES
1) Referral Coordination: Collaborate with healthcare providers, administrators, and other members of care team to coordinate patient referrals to specialty services.
a) Handle confidential information in accordance with HIPAA as well as other related federal and state confidentiality rules.
b) Follows referral policies and workflows.
c) Prioritizes referrals by their urgency and addresses them in a timely manner.
d) Ensures complete demographic, insurance information and appropriate/pertaining clinical information is sent to referred specialists.
e) Contacts insurance companies to ensure prior approval requirements are met. Presents necessary medical information such as, history, diagnosis and prognosis to insurance companies if deemed necessary to prove medical necessity of services.
f) Reviews details and expectations about the referral with both ordering providers and patients.
g) Requests new referrals to be ordered when applicable.
h) Identifies and utilizes community resources; establishes relationships with servicing providers and personnel.
i) Point of contact for patients and specialists for any questions or rising concerns. Assist in problem solving potential issues related to their referral due to language or social barriers. If unable to help, assist in finding the right point of contact to further help.
j) Maintain ongoing tracking and appropriate documentation on referrals.
k) Remind patients of their approved specialty appointments via mail or phone.
l) Assists in navigation of patient to services and regarding referral needs.
2) Performs other duties as assigned. Effectively carries out tasks and responsibilities beyond core job duties and primary role. The additional duties may vary from time to time and encompass a wide range of activities that contribute to the overall success of the organization (floating, schedule variations, assisting co-workers, patients, visitors, customers, leaders, and other stakeholders in support of the organization.)
MISSION, VISION, AND VALUES
1) Empathy - Demonstrates empathy and respect for diversity in the workplace by treating all patients, guests, and colleagues with politeness and inclusivity. Open to learning from different perspectives and experiences.
2) Excellence - Maintains ethical and safety standards and shows integrity in work-related activities. Aims for excellence in job performance.
3) Enjoyment - Shows gratitude, appreciation, a commitment to learning, and professionalism by seeking feedback, accepting constructive criticism, and being open to growth and improvement in their job role.
4) Commitment to Patient/Customer Service - Exhibits good patient/customer service skills and professionalism during patient, customer, colleague interactions. Uses effective communication skills, listens to patients/customers, and responds to inquiries and concerns in a timely manner. Handles challenging situations professionally, ensuring timely resolution of problems to create positive patient/customer experiences.
CULTURE
1) Gratitude - Maintains a positive attitude and acknowledges the value of contentment and well-being in oneself and others.
2) Collaborative Team - Shows adaptability, enthusiasm, and a readiness to work with others in an inter-professional team for organizational purposes. Identifies and encourages opportunities for the professional growth of team members.
3) Quality Improvement - Works together with the team to promote ongoing improvement efforts aimed at enhancing quality standards, processes, and results.
4) Accountability - Follows regulatory guidelines and HealthPoint policies and procedures consistently. Takes responsibility for mistakes and errors when they occur.
QUALIFICATIONS:
GENERAL PROFESSIONAL DEVELOPMENT
This position requires a high level of professionalism, strong communication and interpersonal skills, and the ability to handle sensitive and confidential information with discretion.
1) Organizational Skills - Displays more advanced organizational skills, to organize projects or the work of others.
2) Problem Solving Skills - Devises effective solutions to situations encountered which
include general goals and objectives.
3) Communication Skills - Able to effectively communicate opinions drawn from conclusions using inference and logic.
4) Critical Thinking Skills – Uses logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions, or approaches to problems.
5) Problem Resolution - Resolves conflicts that may arise because of disagreements between employees, between employees and customers/clients.
PROFESSIONAL/TECHNICAL KNOWLEDGE, SKILLS & ABILITIES
1) Required: Processes work-relates skills at a higher level than completion of high school, including formal written and verbal communication skills computational and computer skills mathematical technical or health care related knowledge frequently acquired through a trade school, paraprofessional, or certificate type program.
2) Preferred: Possess specific knowledge of healthcare processes and practices typically acquired during completion of a certified medical assistant program or health related care program.
LICENSES, CERTIFICATIONS & EXPERIENCE
1) Required: High school diploma or equivalent
2) Required: Valid state Driver’s License or with reliable transportation.
3) Preferred: Experience with medical referrals, insurance verification, or patient scheduling is highly preferred
TECHNICAL SKILLS
1) Electronic Medical Record Skills - Demonstrates necessary proficiency with all electronic clinical systems, including EHR and scheduling systems, in use at the health center.
2) Familiarity with medical terminology, procedures, and pharmacology, including medication administration procedures
3) Proficient with typical office equipment: Copier, telephone, Fax
COMMUNICATIONS SKILLS
1) Possesses a level of written and verbal communications, including formal written and verbal communication skills frequently acquired through a trade school, paraprofessional, or certificate type program.
PHYSICAL DEMANDS: Work is performed in a typical office setting.
QUALIFICATIONS:
GENERAL PROFESSIONAL DEVELOPMENT
This position requires a high level of professionalism, strong communication and interpersonal skills, and the ability to handle sensitive and confidential information with discretion.
1) Organizational Skills - Displays more advanced organizational skills, to organize projects or the work of others.
2) Problem Solving Skills - Devises effective solutions to situations encountered which
include general goals and objectives.
3) Communication Skills - Able to effectively communicate opinions drawn from conclusions using inference and logic.
4) Critical Thinking Skills – Uses logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions, or approaches to problems.
5) Problem Resolution - Resolves conflicts that may arise because of disagreements between employees, between employees and customers/clients.
PROFESSIONAL/TECHNICAL KNOWLEDGE, SKILLS & ABILITIES
1) Required: Processes work-relates skills at a higher level than completion of high school, including formal written and verbal communication skills computational and computer skills mathematical technical or health care related knowledge frequently acquired through a trade school, paraprofessional, or certificate type program.
2) Preferred: Possess specific knowledge of healthcare processes and practices typically acquired during completion of a certified medical assistant program or health related care program.
LICENSES, CERTIFICATIONS & EXPERIENCE
1) Required: High school diploma or equivalent
2) Required: Valid state Driver’s License or with reliable transportation.
3) Preferred: Experience with medical referrals, insurance verification, or patient scheduling is highly preferred
TECHNICAL SKILLS
1) Electronic Medical Record Skills - Demonstrates necessary proficiency with all electronic clinical systems, including EHR and scheduling systems, in use at the health center.
2) Familiarity with medical terminology, procedures, and pharmacology, including medication administration procedures
3) Proficient with typical office equipment: Copier, telephone, Fax
COMMUNICATIONS SKILLS
1) Possesses a level of written and verbal communications, including formal written and verbal communication skills frequently acquired through a trade school, paraprofessional, or certificate type program.
PHYSICAL DEMANDS: Work is performed in a typical office setting
