Referral Specialist
Description
Job Duties
- Establish effective communication systems and mutually beneficial relationships with external and internal suppliers and partners.
- Create and maintain ongoing tracking and appropriate documentation on referrals to promote team awareness and ensure patient safety.
- Ensure complete and accurate registration, including patient demographic and current insurance information.
- Assemble complete information concerning patient’s clinical background and referral needs. Per referral guidelines, provide appropriate clinical information to specialist.
- Collaborate with prior auth department to contact review organizations and insurance companies to ensure prior approval requirements are met. Present necessary medical information such as history, diagnosis and prognosis.
- Provide specific medical information to financial services to maximize reimbursement to the hospital and physicians.
- Communicate details and expectations about the referral with patients.
- Assist patients in problem solving potential issues related to the health care system, financial or social barriers (i.e., communicate need for interpreters as appropriate, transportation services or prescription assistance)
- Serve as the system navigator and point of contact for patients and families, with patients and families having direct access for asking questions and raising concerns. May assume advocate role on the patient’s behalf with the insurance carrier to ensure approval of the necessary supplies/services for the patient in a timely fashion.
- Identify and utilize cultural and community resources.
- Establish and maintain relationships with identified service providers.
- Ensure that referrals are addressed in a timely manner and communicated with Clinic Coordinator.
- Ensure that all referral information is present and correct in the EMR, including specialist consults, hospitalizations, ER visits and community organizations related to their health.
- Assemble information concerning patient’s clinical background and referral needs.
- Maintain knowledge of NCQA and TJC standards and ongoing standards compliance
- Consult, work collaboratively and maintain a positive working relationship with other disciplines, participates in the plan, design and evaluation of services.
- Keep current of best practices, current trends and developments in ambulatory services.
- Establish professional relationships with providers, key stakeholders and community agencies to facilitate communication, collaboration and management of patient centered holistic care.
- Assist in development and implementation of systems, policies, and procedures for the identification, collection, and analysis of performance measurement data.
- Assists in analyzing, updating, and modifying standard operating procedures and processes to continually improve operations including but not limited to quality of care, patient experience and engagement.
- Working knowledge of ambulatory care, service delivery. clinical operations, workflows and clinical data analysis and reporting.
- Work as a catalyst to promote services to staff, physicians, patients and community.
- Acquires knowledge for new technology and policy/procedure revisions.
- Assists in training staff as needed.
- All other duties as assigned.
High School Diploma (Equivalent) Required
Associate in Business Preferred
Experience
- Two years of medical receptionist / information clerk experience preferred.
- Two years of related clinical experience preferred, preferably in ambulatory care, community public health, case or care management, or coordinating care across multiple settings and with multiple providers.
- Two years of experience in information systems with scheduling and resource management emphasis, highly desirable.
Nashville General Hospital is an Equal Opportunity Employer/Disability/Veteran
We are an E-Verify employer.
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