A Referral Specialist will work closely with providers to coordinate the referral for patients. Have clear and organized communication with the patient in regard to their referral process and appointment.
ESSENTIAL FUNCTIONS:
· Answers and refers phone calls using professional telephone etiquette.
· Effective communication between patient, specialists, and PCP relaying messages with ongoing updates at various stages of the referral.
· Has the ability to distinguish and extract pertinent clinical information from the medical record to process the referral in a timely manner.
· Responsible for the documentation and implementation/coordination related to all outgoing and internal referrals.
· Send all records to specialists as requested.
· Monitor all assigned work queues and processes to ensure that referrals and authorizations are responded to in a timely manner.
· Review referrals for basic elements and refer to appropriate staff if applicable.
· Receive all pertinent referral information, and forward requests to PA for insurance approval.
· Stays up to date on Cerner changes.
· Maintain ongoing tracking and appropriate documentation on referrals to promote team awareness and ensure patient safety.
· Assemble information concerning patient's clinical background and referral needs. Per referral guidelines, provide appropriate clinical information to specialist.
· Be the system navigator and point of contact for patients and families, with patients and families having direct access for asking questions and raising concerns.
· May assume advocate role on the patient's behalf with the carrier to ensure approval of the necessary supplies/services for the patient in a timely fashion.
· Assists with the training of new referral specialists, as needed.
· Ensures Relias competencies are met.
· Ensures all patient information is complete and accurate to include appointments are scheduled for appropriate duration/diagnosis and on the correct MRN.
· Protects privacy and confidentiality of patients by not discussing protected health information.
· In public areas (e.g., elevators, hallway, etc.). Keeps voices low to allow for privacy for callers.
· Performs such related duties not listed herein but deemed in the best interest of the Medical Practices and NMMC.