Job Title: Referral Specialist

Position Summary

This position is responsible for performing duties associated with patients being referred by their Hamilton Community Health Network primary care physicians to specialists or institutions for additional health care. Understands that employment is contingent upon adherence to HCHN policies and procedures, the mission of the organization, JCAHO policies and procedures, OSHA standards and all other safety and health codes and laws.

Duties & Responsibilities

General responsibilities

• Ensures referrals are made for patients once received from the provider or the assigned MA within 24 hours of receipt of the paperwork from the provider.
• Researches the patient's managed care organization plan to ensure that the referral is made to the proper provider within the patient's network.
• Responsible for following the guidelines as determined by each managed care plan specific to their referral process and for obtaining the appropriate authorizations. This includes:
• Obtaining appropriate demographic identification for each managed care plan and utilizing specific forms/data entry as specified.
• Preparing authorization with patient diagnosis and request from the primary care physician any other need information.
• Responsible for faxing or mailing the authorization forms for referrals prior to the patient's appointment time.
• Weekly responsible for maintaining and updating their individual referral specialist log.
• Maintaining the network's excel spread sheet for every referral completed and ensuring that required data is updated.
• Documenting attempts made to secure the consults as well as information regarding patient's compliance with appointments.
• Documenting if a patient kept specialist appointment or if a second appointment is needed.
• For missed appointments, the referral specialist will schedule new appointments.
• Following up to ensure that consultations are received for those appointments kept by requesting the consultants from the specialist if it is not received within 7 calendar days.
• Tracking referrals to ensure that necessary information is obtained for the patient's chart.
• Attend seminars or training sessions as appropriate for new managed care programs and/or for updates on existing programs.

• Maintain up-to-date information of referral guidelines, active providers, necessary coverage information, and private insurance requirements necessary for pre-certification or outside referral as well as other related information.

   

• Answer questions from HCHN patients requesting referral assistance and/or from referring physicians to ensure efficient patient referral and complete patient information. Questions may be related to:

• Status of referral authorizations sent to the specialist.
• Patient information, such as current medication list and problem lists are sent to the specialist.
• Functions as the liaison with referral sources, managed care representatives, patients and physicians concerning the network of care overseen by primary care providers in Hamilton Community Health Network.
• Mail, fax or communicate additional, appropriate records, certificates and authorizations to appropriate persons for the completion of the referral process as required by managed care providers.
• Ability to evaluate patient's response to care through observation.
• Communicates with patients to resolve issues of patient flow and at times when waiting room overflow is an issue.
• Professionally handles patient complaints.
• Other duties as assigned.

Job Requirements

Education and/or Experience

High School Diploma or G.E.D. required. Some colleg