Patient Referral Specialist

POSITION:

Patient Referral Specialist (PRS)

RESPONSIBLE TO:

Medical Records Supervisor

DEPARTMENT:

Medical Records

SUMMARY:

The Patient Referral Specialist (PRS) is responsible for the tracking and scheduling of Patient Referrals to outside specialist providers and ancillary services to meet the care plans as determined by Camarena Health providers. The PRS staff shows genuine warmth to those they come into contact with (both patients and outside provider/agency personnel). The PRS are accountable for monitoring the continuity of service by tracking whether or not patients made their scheduled appointments by closing referral cases and communicating these outcomes to Camarena Health provider staff. S/he is expected to communicate and provide information that is needed by patients in order to support their health needs.

EXPECTATIONS:

· Arrives on time and adheres to set schedule.

· Promotes health care access by making timely referral appointments for patients.

· Handles referral related telephone calls and processes according to the patients’ needs in a quick and efficient manner.

· Consistently monitors referral status and obtains reports or reschedules appointments as necessary.

· General knowledge and understanding of HIPAA requirements.

· Use of professionalism and best efforts in your position.

DUTIES and RESPONSIBILITES

1.0 Focus on Referral Process:

1.1 Supports the service delivery area by accurately processing referrals and demonstrating knowledge on types of services that are available to our patients, both internal and external.

1.2 Primary focus is handling provider requests for referral appointments for patients in an efficient and timely manner.

1.3 Review referral type against type of insurance coverage to ensure appropriate access to outside provider and ancillary services. This is accomplished by communicating, as appropriate with internal membership services and insurance companies.

1.4 Responsible for quality of work by collecting required information (e.g., patient demographics, facility or referral providers’ name, address, etc.) accurately.

1.5 Supports the needs of the patient by expediting the Patient Referral process by getting prior authorization for Patient Referrals when necessary.

1.6 Supports the needs of the patient by engaging in discussions regarding the preferable appointment date and times for the patient. Additionally, this may determine possible additional needs for patient which may include negotiations with specific facilities to obtain appointments at times most beneficial for patients.

1.7 Coordinates patient information with referral facility, providing necessary documentation to referral provider (e.g., labs, x-ray, physician’s notes, etc.).

1.8 Supports the patient by preparing a referral information packet (e.g., original referral, copy of progress notes, x-rays, directions, etc.) .

1.9 Supports the patient by informing, by mail, their appointment time including specific instructions related to the procedure (e.g., NPO, withhold medications, etc.); provides clear directions to referral address.

1.10 Supports the team by completing dental scanning activities.

1.11 Effectively communicates through active listening, acknowledgment of other’s issues, concerns, and clear understanding of what is said by the accurate message taking, both verbally and written.

1.12 Maintains timely responsiveness to patient care needs daily by sorting, handling and routing of all incoming mail to respective providers.

1.13 Supports the continued development of the team by actively taking responsibility for the cross training and support of team members to serve as back up for PRS in providing continual quality of service to patients.

2.0 Focus on Tracking/Reports:

2.1 PRS team members are responsible for the collection of patient information and ensuring that patient cases are followed through to the logical conclusion.

2.2 Supports Camarena Health functions and patient service by maintaining records of patients referred out to external facilities, providers, and ancillary services.

2.3 Ensures quality of care by tracking Patient Referrals consistently and accurately to assure continuity of care.

2.4 Consistently and accurately enters information into the computer and updates patient information as it becomes available through the effective use of Camarena Health medical management software. Needs to obtain, relay, and document messages received from patients, providers, and staff in the Electronic Health Record System.

2.5 Supports the team objectives by maintaining communication with providers, patients, and staff regarding status of referrals.

2.6 Completes reporting requirements by printing open referral reports and conducting follow-up by requesting consultation reports or rescheduling appointments in accordance with Camarena Health Referral Protocol.

2.7 Complete CHDP reporting for the State of California and Madera County.

3.0 Focus on Corporate Expectations/Standards:

3.1 Attends and actively participates in all meetings (e.g., team meetings, department meetings, program meetings, case management meetings, employee staff meetings) and other activities as required or assigned.

3.2 Attends workshops/seminars as necessary to increase skills and knowledge to provide effective support.

3.3 Works flexible or extended hours where necessary.

3.4 Demonstrates awareness of, and compliance with, organizational mission and objective of Camarena Health to provide health care access and support services for all members of the community.

3.5 Other work-related duties as assigned by supervisor; duties and responsibilities may be added, deleted, or changed at any time at the discretion of management, formally or informally either verbally or in writing.

3.6 Maintains confidentiality and respect for information regarding patients and other team members; abides by Camarena Health Rules of Confidentiality

Minimum Requirements:

Education:

• High School Diploma or GED.
• Some College Preferred
• Completion of Medical Terminology Coursework
• Strong understanding of ICD-9 coding guidelines
• Strong understanding of CPT coding guidelines

Prior Experience:

• Minimum of three (3) years previous clerical experience in a healthcare setting with focus on skills listed below.

Skills:

· Bilingual (English-Spanish) preferred.

· Excellent oral and written skills.

· General knowledge of understanding of insurance plans and processes.

· General medical and dental terminology and standard abbreviations used in medical and dental notations.

· Promptness; strong sense of timeliness.

· Telephone courtesy; communication is mutually effective and efficient.

· Customer-service oriented.

· Strong organizational skills.

· Intermediate to expert user computer skills; demonstrates proficiency with Windows-based applications and practice management software.

· Minimum 45 wpm.

· Data management and reporting.

· 10 Key Calculator

· Diagnostic indexing

· ICD-9 Coding

· Attention to detail and excellent follow-through on work tasks.

· Demonstrates good problem-solving skills.

· Able to track multiple tasks and complete promptly.

· Able to quickly build and maintain rapport with patients and providers of differing backgrounds; team player.

Physical Requirements:

• Must be able to move up to 20 pounds and push up to 50 pounds (on wheels)
• Must be able to hear staff on the phone and those who are served in-person, and speak clearly in order to communicate information to clients and staff
• Must be able to read memos, a computer screen, personnel forms and clinical and administrative documents
• Must have high manual dexterity

· Must be able to reach above the shoulder level to work, bend, squat and sit, stand, stoop, crouch, reach, kneel, twist/turn