Logo
Central Florida Health Care

Referral Specialist

Central Florida Health Care, Winter Haven, FL, United States

Title: Referral Specialist

Recommended by: Health Services Manager

Approved by: Chief Operations Officer

Reports to: Health Services Manager

Position Summary:

The Referral Specialist is responsible for performing all aspects of the patient referral process including coordinating and completing referrals ordered by CFHC providers, acquiring and verifying third party information for referrals, obtaining referral appointments, and tracking referrals.

Qualifications:

Certified and Registered Medical Assistants preferred

High School graduate or GED required

Experience preferred Computer literacy

Knowledge and Skills:

  1. Knowledge of basic medical terminology
  2. Knowledge of various insurance programs (example, Medicaid)
  3. Strong customer service focus
  4. Effective verbal and written communication skills
  5. Organized and able to manage competing priorities
  6. Resourcefulness in problem solving
  7. Able to take and follow through with delegated tasks
  8. Team oriented
RESPONSIBILITIES AND PERFORMANCE EXPECTATIONS: may include, but are not limited to, the following:
  1. 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.
  2. Be competent in performing the duties of a referral specialist.
  3. Report as needed to COO any pertinent information or situations that impact on patient care or CFHC liability.
  4. Attend and participate in mandatory CFHC meetings (Center Specific meetings, Corporate meetings, and other meetings as designated by the COO or CEO).
  5. Demonstrate ability to work cooperatively with other members of the clinical team. Be supportive of coworkers.
  6. Maintain a neat and professional appearance at all times.
  7. Carry out any other activities deemed appropriate by the COO or CEO.
DUTIES OF A REFERRAL SPECIALIST: include, but are not limited to, the following:
  1. Coordinate all aspects of completing referrals ordered by CFHC providers
  2. 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
  3. Obtain appropriate authorizations from insurance companies sending necessary documentation from the patient's medical record as required
  4. 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)
  5. Notify patient of scheduled referral appointment
  6. Document appropriately and thoroughly
  7. 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.
  8. Notify the ordering provider and/or Health Services Manager 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
  9. Maintain specialty provider list including payor sources they accept
  10. Review referral log weekly to ensure completion of all referrals
  11. Other duties as assigned by Health Services Manager
The job description is not intended to be all-inclusive, and employee will also perform other reasonable related business duties as assigned by supervisor.

PHYSICAL REQUIREMENTS
  1. Requires 80% or more time spent sedentary.
  2. Independently mobile.
  3. Ability to lift weight equivalents that would be required with re positioning equipment and lifting supplies.
  4. Ability to adapt and function in varying environments of workload, patient acuity, work sites, and work shifts.


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.