Referral Specialist

Position Impact and Purpose…

Our Centers are dedicated to growing healthy communities by “providing access to affordable, high quality, integrated health care to all.” As a Referral Specialist you will ensure patients have been cleared for specialty service office visits and resolve pre-certification, registration and case-related concerns prior to a patient’s appointment. The Referral Specialist is a champion for providing a positive patient centered experience for Valley View clients. Through effective communication the Referral Specialist will coordinate the management of identified specific care needs, referrals, and follow up to mitigate potential gaps in health care with a specific focus on care tracking. Efforts of the Referral Specialist will directly impact Continuous Quality Improvement (CQI) by increasing patient responsiveness to care needs leading to improved quality measures and outcomes.

Essential Functions…

Functional Area: 

Referrals and Referral Tracking

Estimated Effort:  70%

Responsibilities, Deliverables, Outcomes and Expectations

 ·         Receive new patient referrals

 ·         Address all referrals in a timely manner

 ·         Perform outbound calls to providers to gather required information

 ·         Contact external specialty offices and schedule appointments via phone or fax

 ·         Maintain and exceed overall weekly goals of processed referrals

 ·         Process referrals within regulated time frames to ensure members receive care in a timely fashion

 ·         Set reminders in the electronic medical record to follow up with external providers

 ·         Run open referral report weekly from AZARA

Functional Area: 

Communication

Estimated Effort:  20%

Responsibilities, Deliverables, Outcomes and Expectations

·         Resolve patient inquires including, data processing and status updates

·         Refer cases as needed for review to Pre-Authorization Specialists

·         Create solid relationships with doctor’s offices to ensure first referral preference

·         Complete telephone messages timely

·         Responsible for accurate and timely documentation

 Functional Area:

Follow Up

Estimated Effort:  10%

Responsibilities, Deliverables, Outcomes and Expectations

·         Check Clinisync daily for labs, diagnostic referrals, and consult notes

·         Check for pending and outdated referrals daily

 Minimum Requirements…

Education: 

High School Diploma or equivalent

CPR Certification

Agency Requirements:

Current valid driver’s license, proof of automobile insurance, insurable under agency insurance policy, reliable transportation, compliance with VVHC’s employee uniform/attire

People Management Experience:

Licenses, Certifications, and Accreditations:

Preferred Qualifications…

Prior experience with electronic medical records.

Certified Medical Assistant, Emergency Medical Technician, or Licensed Practical Nurse

Previous office experience or experience with insurance referrals and authorizations

Working Conditions…

Primary work conditions are indoors in climate-controlled setting in an office like environment.   The employee may be exposed to hazardous materials and various weather conditions.  The employee must regularly move up to 10 pounds and occasionally move up to 25 pounds.  Specific vision abilities required by this job include close vision.  While performing the duties of this job, the employee will regularly remain at a desk; use hand to finger, handle or feel object, tools or controls; reach with hands and arms; and exchange accurate information.   The employee is occasionally required to move from one place to another. Any travel required for this position is reimbursed at a rate outlined in procedure 03.03.12.06.