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POSITION SUMMARY:  

The Referral Specialist supports continuity of care by acting as a liaison between patients and services that are not part of the concurrent patient visit. This role is responsible for working closely with providers, nursing, clinical support and the health plans to accurately initiate and complete the patient referral process, obtain prior authorization and initiate testing outside of the organization that requires a prior authorization. Performs other duties as assigned or required.

*DUTIES AND RESPONSIBILITIES:  *

• Communicate 
  1. With patient and referral sources via telephone, mail and digital advising of scheduled appointments well in advance of the scheduled appointment date. 
  2. With the specialty office to obtain all pertinent information and all involved in the referral process. 
  3. With specialty providers and internal and external staff to assist in resolving pending, denied and other problematic referrals.
  4. With the provider any problems regarding referrals or prior authorizations
  5. With the provider for decisions that are made by patients' health plans regarding prior authorizations for treatment.
• Obtain authorization from the health plan by calling or faxing related patient information.
• Monitor open referrals or those pending in the order tracking system to assure continuity of care.
• Maintain referral tracking database and monitor referral log for specialist reports.
• Close all referrals per the referral follow-up procedure.

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``` - Assures quality of care by adhering to evidence-based care guidelines; measuring health outcomes against patient care goals and standards; making or recommending necessary adjustments; following standards of care set by state and other governing agency regulations.

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``` - FHC Employee Engagement: participates in organizational events within the community and Family Health Center. - Maintains professional and technical knowledge by attending educational workshops:   monthly staff meetings and clinical committees.

*TYPICAL PHYSICAL DEMANDS:  *

• While performing the duties of this Job, the employee is regularly required to use hands to finger, handle, or feel and talk or listen. 
• The employee is frequently required to stand and walk. 
• The employee is occasionally required to sit; reach with hands and arms and stoop and kneel. 
• The employee must occasionally lift and/or move up to 25 pounds. 
• Specific vision abilities required by this job include close vision, color vision and ability to adjust focus.

QUALIFICATIONS:

• Insurance coding and medical terminology
• Medical Office Experience
• Familiarity with insurance programs, preauthorization and/or referrals
• Effectively uses Healthcare information systems, such as electronic health records and practice management systems experience.
• Multi-line phone proficiency
• Knowledge of medical terminology 
• Experience in customer service, organizational skills, clinical processes, programs and strong computer skills are highly preferred.

EDUCATION/EXPERIENCE/CERTIFICATIONS/LICENSES:

• High School Diploma or GED, required.
• Medical Assistant or Certified Nursing Assistant preferred.
• An Associate's Degree from an accredited college or university is preferred.
• Experience in a healthcare setting or an equivalent combination of education and experience in a healthcare setting, 1-2 years preferred
• Bilingual (English and Spanish) is highly desired.