What are the responsibilities and job description for the Health Referral Specialist position at St. Joseph's/Candler?
Position Summary
Completes daily review of physician orders for outside referrals and diagnostics. Processes outgoing referrals and diagnostics to other specialty physicians and or medical institutions. Providing documentation for referral or diagnostics to include insurance information. Schedules patients for diagnostic testing or referral as ordered. Completes necessary prior authorizations required for referrals or testing. This position requires working knowledge of other clinic roles and provides assistance in those roles as needed, included but not limited to front office staff backup or practice switchboard operator. Integrates customer service with various types of telephonic and electronic tools to ensure a positive patient experience.
Education
Associates Degree or in lieu of a degree a minimum of 2 years of college - Required
Experience
2-3 Years Medical Office - Required
1 Year Prior Authorization Management - Preferred
License & Certification
Professional Certification (CMA, PCT or CNA) - Preferred
Core Job Functions
Monitors physician orders for patient referrals to diagnostic departments, specialists, and initiates referrals; facilitates with CBO the pre-certification process, contacts patients when necessary; provides feedback to providers as needed if delays occur, and maintains outstanding results list to assure patient compliance with physician orders.
Assists to assure provider order entry and supportive care protocols are completed in a timely manner to meet patient expectations, clinical team needs, scheduling, and billing.
Refers patients to correct laboratory, imaging center, hospital or specialist. Ensures precertification is obtained when needed prior to services being rendered. Follows referral process based upon insurance company's policies and procedures. Notify patients of any delays in approval or whenever necessary.
Manage insurance pre-certifications and authorizations as needed for referrals or diagnostics.. Provides timely follow up on all inquiries and requests regarding authorization issues.
Provide clerical support to the office. Answer phones, complete patient requests, and route calls appropriately.
Assist in the coordination of care as directed by office team leads or practice administrator. Including providing coverage for office staff (i.e. switchboard front desk-office coordinators) as requested.
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