Description

POSITION TITLE: Referral Specialist

DEPARTMENT: Clinic

EMPLOYEE REPORTS TO: Clinic Manager

SUPERVISES: None

FLSA STATUS: Non-exempt

EMPLOYMENT STATUS: Full-time

Description of Position

This job description is a record of the essential functions of the listed job. The job description provides the employee, Administration, Human Resources, applicants, and other agencies with a clear understanding of the job, where it fits into the organization, and the skill and work requirements in relation to other jobs. Jobs are always changing to some degree and the existence of the approved job description is not intended to limit normal change and growth. The facility will make reasonable accommodations to otherwise qualified individuals who are capable of performing the essential functions of the job with or without reasonable accommodation.

POPULATION SERVED

The position involves direct and indirect patient care for a population of patients between

the ages of 18 and older. Age specific experience and/or special training and/or expertise

is required to serve this population.

POSITION SUMMARY

The Referral Coordinator is responsible for handling referrals within the rural health

clinics. Receptionist responsibilities include, but not limited to, greeting patients,

answering phones, making appointments, maintaining patient charts and organizing all

clerical duties. Act as receptionist on a backup basis.

PRIMARY RESPONSIBILITIES WILL INCLUDE:

Takes telephone request for authorizations.
Prepares referral requests.
Track referral process, utilizing a tracking log. Responsible for insuring referral correspondence is received and reviewed by provider.
Generates reports that summarize referrals and authorization activity.
Handles all incoming telephone calls and exercises judgment as to the urgency or other nature of the calls and directs them to appropriate personnel. Answers the telephone professionally, identifying self and department. Handles telephone information requests with courtesy, accuracy and respect for confidentiality.
Makes future appointments and answers all inquiries
Completes various agency forms and records
Types and maintains all patient medical files, making sure that all documents are filed in the correct location of the patient chart.
Inventories and orders all offices supplies regularly
Utilizes company supplies efficiently.
Reviews patient chart for accuracy of billing information, verifying correct insurance information, accepting co-payments and running POS on all Medi-Cal/Hap cards.
Assures timely distribution of all paperwork to all involved areas of the hospital.
Maintains the confidentiality of patient and facility records and information.
Immediately greets/acknowledges guest’s presence in a courteous and caring manner.
Demonstrates the ability to prioritize and deal with immediate guest needs first, and paperwork processing second.
Confirms appointments on a daily basis.
Charts all action taken accurately and timely.
Initiates procedures for emergency care that require immediate action, following pertinent policies/procedures.
Answers telephones, directs call to appropriate personnel and takes patient referral information.
Researches appropriate ICD-10/CPT codes for authorization to refer patient for care.
Cooperates in developing office forms and procedures.
Greets patients and assists them with registration forms and health information forms.
Performs clerical duties, i.e., photocopying, A-Z filing, as well as other duties assigned.
Review patient chart for accuracy of billing information and ensure medical/legal compliance with Consent for Treatment and third-party requirements, such as pre-admission authorizations and second surgical opinions.
Assure timely distribution of all paperwork to all involved areas, such as Business Office billing and physician’s offices.
Ensure enforcement of hospital collection and insurance verification policies.
Translate for patients and/or staff.
Register patients into the HMS system.
Obtain prior authorizations.
Must be able to demonstrate the knowledge and skill necessary to provide care and/or services appropriate to the age of the patients served in his/her assigned area. The skills and knowledge needed to provide such care may be gained through education, training or experience.

Requirements

POSITION QUALIFICATIONS

Six months to one year of related experience and/or training; or equivalent combination

of education and experience. Ability to read and interpret documents such as safety

rules, operating and maintenance instructions, and procedure manuals. Ability to read

and write English. Bi-lingual (Spanish preferred). High School graduate or G.E.D.

equivalent. Must be able to perform duties with minimum supervision.

PROFESSIONAL REQUIREMENTS:

Provides an environment that demonstrates competence, caring, and commitment to external and internal customer satisfaction.
Remains calm in stressful situations.
Demonstrates appropriate customer relations communications skills, actively listening, maintaining eye contact, using guest names, anticipating customer needs, and proactively offering assistance.
Demonstrates good rapport and cooperative working relationship with all hospital staff.
Does not abuse or take advantage of sick time or personal days off. Provides proper notification for absence or tardiness.
Makes best use of time during assigned shift. Coordinates activities to achieve maximum productivity and efficiency during assigned shift. Attends to personal affairs on own time to avoid disrupting the work schedule.
Performs duties in an independent manner with minimum supervision.
Reports to work as scheduled; is consistently ready to work at start of the assigned shift. Reports off duty as scheduled; does not abuse overtime policy.
Completes time sheet accurately and on a daily basis.
Conducts himself/herself in a professional manner at all times.
Observes the Hospital/department dress code and wears ID badge.
Attends all required education/inservice meetings.
Always utilizes Standard Precautions for infection control.
Demonstrates continuing effort to maintain positive relationships with physicians, peers, administration, and the public.
Demonstrates knowledge of and adheres to hospital and departmental safety regulations, disaster plans, infection control policies, and fire safety regulations, hazardous materials protocol.
Demonstrates a working knowledge and understanding of National Patient Safety goals.
Responds to and uses disaster codes appropriately.
Performs other related duties as assigned or requested.

DEMANDS AND CHARACTERISTICS OF WORK, EQUIPMENT USAGE, AND WORK

ENVIRONMENT

PERCENTAGE OF WORK TIME

Standing/Walking -1-33%
Sitting -34-66%
Twisting -1-33%
Lifting/Carrying -1-33%
Pushing/Pulling -1-33%
Climbing (Ascending/descending) -1-33%
Bending/Stooping -1-33%
Using arm muscles frequently or for extended periods. -1-33%
Using leg muscles frequently or for extended periods. -1-33%
Using back muscles frequently or for extended periods. -1-33%

LIFTING REQUIREMENTS – Individuals in patient care positions are required to lift a patient with or without assistance.

2-10 Pounds -67-100%
11-20 Pounds -67-100%
21-30 Pounds -34-66%
31-40 Pounds -34-66%
41-50 Pounds -1-33%
51 Pounds or More -1-33%

WORKING ENVIRONMENT

Working in hot, cold, wet surroundings -1-33%
Working outdoors -1-33%
Working with or near chemicals -34-66%
Working near radiation sources -1-33%
Potential exposure to communicable diseases -1-33%
Working with hazardous waste materials -34-66%
Utilizing essential upgraded or adaptive equipment as industry standards require -34-66%
Using hand tools -1-33%
Operating vehicle -1-33%
Potential for cuts and bruises -1-33%

EXCHANGE OF IDEAS

Ability to express or exchange ideas. -67-100%
Ability to understand communication of others with or without adaptive devices. -67-100%
Ability to perform secondary math. -67-100%
Ability to read at a secondary level. -67-100%

WORKPLACE BEHAVIORS

I. RESULTS ORIENTATION – Meets current objectives and positions the

organization for future growth. Completes daily tasks and assignments and

processes large volumes of work associated with the operation of the department.

II. SOCIAL SENSITIVITY - Builds positive relationships based on respect for others.

Demonstrates a helpful, positive attitude. Maintains effective communication with

peers, medical staff, patients, visitors, and families.

III. QUALITY OUTCOMES – Meets and exceeds expectations of internal and external

customers. All organizational and departmental standards regarding quality of

performance are met. Demonstrates a strong commitment to confidentiality.

Participates in quality improvement programs as directed.

IV. SAFE WORKING ENVIRONMENT – Demonstrates an awareness of and

adherence to safety and legal requirements established at the facility with an

emphasis on maintaining a safe environment for all persons working in the facility.

Accident/Injury Reporting – Reports any accidents, injuries, and unsafe equipment and conditions to supervisor by the end of the shift and reports any pre-existing conditions as identified by the ADA.
Unsafe Conditions – Immediately reports and corrects, if possible, unsafe conditions or equipment.
Workplace Standards – Compiles with relevant regulations, standards and policies governing safe workplace environment (OSHA, Accreditation, etc.)
Safety Techniques – Maintains current knowledge of all aspects of the facility’s safety program by attending safety-related training as mandated upon hire and thereafter as required by facility.
Modified Work – Accepts modified work assignments after receiving the physician’s release to return to work following an accident/ injury.
Follows Prescribed/Recommended Treatment – Follows the prescribed/recommended treatment given by treating physician(s) after an accident/injury.

V. EDUCATION – Participates in required in-service and educational programs on an ongoing basis.

VI. ATTENDANCE AND PUNCTUALITY – Follows all facility guidelines outlining

standards of attendance and punctuality. Responsible for reporting to and

completing work at assigned times.

UNIVERSAL PRECAUTIONS

Universal precautions will be observed in order to prevent contact with blood or other

potentially infectious materials. Under circumstances in which differentiation between

body fluid types is difficult or impossible, all body fluids shall be considered potentially

infectious materials. All blood or other potentially infectious materials will be considered

infectious regardless of the status. The categories shown below are designed to

communicate the risk of exposure for this particular position.

Category I

Tasks involve light contact with moist body substances, non-intact skin or mucous

membranes. Department procedures define and require use of minimum protective

measures to perform the task.

Category II

Tasks involve no contact with moist body substances, non-intact skin or mucous

membranes; however, employment may require performing unplanned Category I task.

Appropriate protective measures are readily available.

Category III

Tasks of employment involve no contact with moist body substance, non-intact skin

or mucous membranes. The employee must have the ability to perform essential

functions without posing a “direct threat” in the workplace.

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