<p>Title: Specialty Referral Specialist</p> <p>Reports to: Referral Specialist Supervisor</p> <p>FLSA Status: Non-Exempt</p> <p>Personnel Supervised: None</p> <p>POSITION SUMMARY:</p> <p>The Specialty Referral Coordinator is responsible for processing, tracking, and coordinating all outgoing and incoming specialty referrals ordered by or referred to CFHC providers, acquiring and verifying third party information for referrals, obtaining referral appointments, and tracking referrals. This role ensures that referrals are handled efficiently, accurately, and in a timely manner while maintaining excellent communication between providers, patients, and specialty offices. The coordinator acts as a liaison to facilitate continuity of care and is responsible for the following: Reviewing provider orders and initiate specialty referrals, verifying insurance coverage and authorization requirements for referred services, submit prior authorizations as needed and follow up with insurance companies, communicate with patients regarding referral status ,ensure timely follow-up on pending referrals and update electronic medical records (EMR) ,maintain accurate documentation of all referral communications and outcomes coordinate with case managers, providers, and specialists to expedite urgent referrals, track and report referral completion and patient follow-up data ,ensure HIPAA compliance and confidentiality of patient records and respond to inquiries from patients and providers regarding the status of referrals.</p> <p>MINIMAL QUALIFICATIONS:</p> <ul> <li>Certified and Registered Medical Assistants preferred High School graduate or GED required </li><li>Minimum 1-2 years of experience in a medical office, referral coordination, or healthcare administration. </li><li>Familiarity with insurance processes, prior authorization, and medical terminology. </li><li>Proficient in EMR systems and Microsoft Office Suite. </li><li>Strong organizational skills and attention to detail. </li><li>Excellent interpersonal and communication skills. </li><li>Ability to multitask and work in a fast-paced environment. </li></ul> <p>KNOWLEDGE AND SKILLS:</p> <ul> <li>Knowledge of basic medical terminology </li><li>Knowledge of various insurance programs (example, Medicaid) </li><li>Strong customer service focus </li><li>Effective verbal and written communication skills </li><li>Organized and able to manage competing priorities </li><li>Resourcefulness in problem solving </li><li>Able to take and follow through with delegated tasks </li><li>Team oriented </li></ul> <p>RESPONSIBILTIES AND PERFORMANCE EXPECTATIONS include, but are not limited to, the following:</p> <ul> <li>Be familiar with CFHC's program philosophies, goals and objectives. Be cognizant of and comply with all CFHC's policies and procedures, as well as state and federal regulations. </li><li>Be competent in performing the duties of a referral specialist. </li><li>Report as needed to CMO any pertinent information or situations that impact on patient care or CFHC liability. </li><li>Attend and participate in mandatory CFHC meetings (Center Specific meetings, corporate meetings, and other meetings as designated by the CMO or CEO). </li><li>Demonstrate ability to work cooperatively with other members of the clinical team. Be supportive of coworkers. </li><li>Maintain a neat and professional appearance at all times. </li><li>Carry out any other activities deemed appropriate by the CMO or CEO. </li><li>Coordinate all aspects of completing referrals ordered by CFHC providers </li><li>Complete referrals in a timely manner; STAT referrals must be completed by end of business day, URGENT referrals within 24 hours, and ROUTINE referrals within 72 hours </li><li>Obtain appropriate authorizations from insurance companies sending necessary documentation from the patient's medical record as required </li><li>Schedule referral appointments for patient (when applicable) ensuring proper paperwork is faxed to the specialist or given to the patient to take to the appointment (example, labs, x-ray reports, progress notes) </li><li>Notify patient of scheduled referral appointment </li><li>Document appropriately and thoroughly </li><li>Track all referrals accordingly to improve the quality and continuity of care provided to patients. This includes, but is not limited to, initiating reminder calls to patients prior to their scheduled appointment and obtaining the referral report from the specialist. </li><li>Notify the ordering provider and/or Referral Specialist Supervisor of any problems in obtaining a patient's referral, including issues with obtaining authorizations from third party payors or making appointments with a specialist, patient refusal of a referral, or patient no show to scheduled referral appointment </li><li>Maintain specialty provider list including payor sources they accept </li><li>Review referral log weekly to ensure completion of all referrals </li><li>Other duties as assigned by Referral Specialist Supervisor </li></ul> <p>PHYSICAL REQUIREMENTS:</p> <ul> <li>Requires 80% or more time spent sedentary. </li><li>Independently mobile. </li><li>Ability to lift weight equivalents that would be required with repositioning equipment and lifting supplies. </li><li>Ability to adapt and function in varying environments of workload, patient acuity, worksites, and work shifts. </li></ul> <p>American with Disabilities Act (ADA) Statement: External and internal applicants, as well as position incumbents who become disabled, must be able to perform the essential job specific functions (listed within each job responsibility) either unaided or with the assistance of a reasonable accommodation to be determined by the organization on a case by case basis.</p>