Referral Specialist

SUMMARY:

The Referral Coordinator reports to the Prior Authorization Supervisor. Under the general supervision, coordinates the effective and efficient patient flow regarding pre-registration scheduling appointments with specialist and testing per physician request. Obtains proper insurance authorization prior to scheduling appointment and once completed contacts patient with pertinent information and ensures that all required information is forwarded to specialist office following practice protocols. Follows patient's status within the cycle of provider care to ensure continuity of services utilizing LifeChart referral workques. Functions as a liaison between the hospital and patients to facilitate the solution of patient financial issues concerning outpatient registrationins

Coordinates the effective and efficient processing and scheduling of all incoming referrals, adhering to established timelines and departmental procedures.
Brown University Health employees are expected to successfully role model the organization's values of Compassion, Accountability, Respect, and Excellence as these values guide our everyday actions with patients, customers and one another.

In addition to our values, all employees are expected to demonstrate the core Success Factors which tell us how we work together and how we get things done. The core Success Factors include:

Instill Trust and Value Differences
Patient and Community Focus and Collaborate

RESPONSIBILITIES:

PRINCIPAL DUTIES AND RESPONSIBILITIES: Preregister/schedule/coordinate/triage all referrals created by and sent to the practice via Lifechart workques. Sets follow-up alarms per practice protocols and the tracking function to ensure that all outstanding referrals are followed-up on. Monitor/update pre and post registration workqueues. Obtains all un-resulted consults and testing orders managed by the referral office. Alerts the ordering provider of any patient that does not keep an appointment with a specialist or testing facility. Receives and reviews all incoming referrals ensuring completeness and accuracy. Ensures all information is received including patient demographics, insurance and authorizations. Communicates promptly with referring provider and/or patient regarding insurance coverage issues (e.g. non-participation status) so the patient may seek timely services elsewhere. Maintains current knowledge of insurer referraluthorization requirements and have a working understanding of the patient population and demonstrate cultural awareness and sensitivity. Documents any communication with referring providers, patients and/or Clinic (MD, RN, etc.) in the EHR. Collaborate with social work , Patient Financial Advocate and Patient Navigator for Financial Assistance and eligibility. Participates in practice performance and quality improvement activities. Attends required meetings and trainings as directed. Performs other related duties as assigned. Consistently monitors clinic schedules to ensure maximized scheduling and fills any available/open timeslot including those appointments cancelled and/or rescheduled. Notifies Provider and/or Supervisor if unable to schedule referral or if there are access issues. Monitors Referral Work-Queues and ensures that all referrals have been processed accordingly. strike/strike Knowledge of front office operations in addition to clinical knowledge for triaging referrals and determine when the patient need to be seen.

MINIMUM QUALIFICATIONS:

BASIC KNOWLEDGE: High school degree or the equivalent. Billing and medical knowledge preferred. EXPERIENCE: Two years of clinical referral experience preferred. Data entry skills and computer experience required. Strong customer service focus. Effective verbal and written communication skills. Organized and able to manage competing priorities. Able to take and follow through with delegated tasks and accountability. Demonstrated knowledge and skills necessary to provide care to patients throughout the life span with consideration of aging processes, human development stages and cultural patterns in each step of the care process. INDEPENDENT ACTION: Performs independently within department policies and practices. Refers specific complex problems to physician practice manager where clarification of departmental policies and procedures may be required.

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EEO Statement:

Brown University Health is committed to providing equal employment opportunities and maintaining a work environment free from all forms of unlawful discrimination and harassment.

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Driving Required: