Patient Referral Specialist
Company: Camarena Health
Location: Madera
Posted on: May 24, 2023
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Job Description:
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
Keywords: Camarena Health, Madera , Patient Referral Specialist, Other , Madera, California
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