Referral Specialist at Brown Medicine

Providence, Rhode Island, United States -

Full Time

Start Date

Immediate

Expiry Date

26 Jun, 26

Salary

31.39

Posted On

28 Mar, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Referral Processing, Quality Control, Scheduling, Insurance Authorizations, Electronic Health Record (EHR), Triage, Communication, Customer Service, Productivity, Accuracy, Medical Terminology, Prior Authorization, Work Queue Monitoring, Problem Solving, Time Management, Cultural Awareness

Industry

Medical Practices

Description

SUMMARY: The Referral Specialist reports to a Patient Access Supervisor. Under the general supervision, ensures the quality of the referral process is upheld to departmental standards. Evaluates the incoming referral for information that is accurate and appropriately reflects the patient symptom to the requested treatment. Ensures quality control of the referral process is upheld by reviewing the accuracy and timeliness of referrals through monthly standard reports. Coordinates the effective and efficient processing and scheduling of all incoming referrals, adhering to established timelines and departmental procedures. Brown University Health employees are expected to successfully role model the organization's values of Compassion, Accountability, Respect, and Excellence as these values guide our everyday actions with patients, customers and one another. In addition to our values, all employees are expected to demonstrate the core Success Factors which tell us how we work together and how we get things done. The core Success Factors include: Instill Trust and Value Differences Patient and Community Focus and Collaborate RESPONSIBILITIES: Receives and reviews all incoming referrals ensuring completeness and accuracy. Ensures all information is received including patient demographics, insurance and authorizations. Communicates promptly with referring provider and/or patient regarding insurance coverage issues (e.g. non-participation status) so the patient may seek timely services elsewhere. Evaluates and determines triage when reviewing the referral by following established clinic referral guidelines for complete/compliant information. Determines if referral is in need of additional clarification, evaluates the content matter to services requested and determines if the referral needs to be escalated to management for assistance or resolution. Returns incomplete/non-compliant referrals based on triage guidelines to referring physician office indicating the reason for return. Ensures quality control of the referral process is upheld by reviewing the accuracy and timeliness of referrals through Monthly standard reports. Provides accurate and timely communication with patients, referring providers and other staff. Performs at benchmarked levels related to accuracy, productivity, quality and customer service as defined by industry standards and internal quality management. Coordinates and provides guidance to Outpatient Service Representative (OSR) or other staff to ensure proper documentation is made in referral record. Assists and provides support to staff when entering all referral information into the electronic health record (EHR) for any external referrals received including demographics, reason for referral and insurance authorization information. Scans referrals received by fax and/or on paper into the appropriate section of the referral record. Documents any communication with referring providers, patients and/or Clinic (MD, RN, etc.) in the EHR. Responds to incoming telephone calls regarding pending referrals, including timely response to voicemail messages. Coordinates and provides support when scheduling all referral appointments established by practice protocols and specifically those that require prior authorization. Maintains current knowledge of insurer referral authorization requirements, have a working understanding of the patient population, and demonstrate cultural awareness and sensitivity. Schedules appointments according to triage guidelines. Ensures all demographics information is updated, insurance verified and authorizations obtained. Notifies patients of appointment, explains and educates patient to a level of understanding for the preparation needed for the upcoming appointment. Communicates with referring providers and ensures documentation of that communication in the EHR. Documents any and all communication with patients in the EHR. Communicates with referring providers when patients decline appointments and/or do not keep their appointments. Refers patients to the Patient Financial Advocate when necessary. Acts as a liaison/resource with patients, referring providers, community providers and practice team members regarding referral issues utilizing the highest level of customer service. Consistently monitors clinic schedules to ensure maximized scheduling and fills any available/open timeslot including those appointments cancelled and/or rescheduled. Notifies Provider and/or Supervisor if unable to schedule referral or if there are access issues. Monitors Referral Work-Queues and ensures that all referrals have been processed accordingly. Performs other duties as assigned. MINIMUM QUALIFICATIONS: BASIC KNOWLEDGE: Associate degree in health information technology or related field or the equivalent experience in an ambulatory setting. Formal education in medical terminology, anatomy and other coding-related course. EXPERIENCE: Two years of clinical referral experience required and/or at least one year of related experience in coding/billing and medical record operations in an ambulatory care facility Health Information/Medical Record Department. Familiarity and understanding of the content of the medical record. Spanish speaking strongly preferred. Strong organizational skills with a proven ability to prioritize and handle frequent changes in workload and able to manage competing priorities. Excellent customer service and communication skills with the ability to discuss delicate matters with patients and referring providers required. Demonstrated knowledge and skills necessary to provide care to patients through the life span with consideration of aging processes, human development stages and cultural patterns in each step of the care process. WORK ENVIRONMENT AND PHYSICAL REQUIREMENTS: Work is performed in a typical medical office setting requiring extensive sitting, standing and walking. Reads referrals for new patient appointments for the majority of a day. Ability to work under fast paced sometimes stressful conditions to process new patient referrals meeting productivity and accuracy metrics. Organized and able to manage competing priorities ability to use good judgment by showing resourcefulness in problem solving. INDEPENDENT ACTION: Performs independently within department policies and practices. Refers specific complex problems to Patient Access Supervisor or relevant clinic’s Medical Director where clarification of departmental policies and procedures may be required and/or when there are patient access concerns. Able to work independently as well as to network effectively internally with other referral coordinators. Able to take and follow through with delegated tasks and accountability. Ability to recognize and understand clinical triaging. Possess a demonstrated ability to think critically by understanding and properly applying guidelines as provided. Pay Range: $19.03-$31.39 EEO Statement: Brown University Health is committed to providing equal employment opportunities and maintaining a work environment free from all forms of unlawful discrimination and harassment. Location: 117 Ellenfield Street - N/A Providence, Rhode Island 02903 Work Type: M-F 8:00-5:00PM Work Shift: Day Daily Hours: 8 hours Driving Required: No As Rhode Island's largest health system and private employer, Brown University Health is the state's premier provider of health services and includes the only Level I Trauma Center for southeastern New England. Today, more than 20,000 people work at Brown University Health and bring their unique skills, experiences, and compassion to their jobs every day. Formed in 1994, Brown University Health is a not-for-profit health system based in Providence, RI comprising three teaching hospitals of The Warren Alpert Medical School of Brown University: Rhode Island Hospital and its Hasbro Children's; The Miriam Hospital; and Bradley Hospital, the nation’s first psychiatric hospital for children; Newport Hospital, Saint Anne's Hospital and Morton Hospital, community hospitals offering a broad range of health services; Gateway Healthcare, the state’s largest provider of community behavioral health care; and Brown Health Medical Group, the largest multi-specialty practice in Rhode Island. Brown University Health is an equal opportunity employer that values diversity of cultural background, race, gender, age, religion, identity, ability, and perspectives - we are actively committed to a diverse workforce that represents the patients and community that we serve. We are invested in creating a respectful, inclusive, and equitable environment that supports the holistic well-being of our employees and their families. Join us and help build a healthier future for our patients - and for yourself. Company Location Belonging and Engagement Nursing Our Mission

Responsibilities

The Referral Specialist ensures the quality and accuracy of incoming referrals by evaluating patient symptoms against requested treatments and coordinating efficient processing and scheduling according to established timelines. Responsibilities include maintaining quality control through monthly reports, communicating with providers regarding insurance issues, and accurately documenting all interactions in the EHR.