Referral Specialist jobs in Syracuse, NY

Position Overview:

Provides referral support for the professional teams through positive customer service, diagnostic appointment scheduling, processing insurance authorization, maintaining and organizing appropriate documentation, copying, faxing completed orders, and other clerical duties as required.  Works with the physicians, managers and staff to promote quality and cost effective daily operations. Establishes and maintains good interpersonal relationships with patients, their families, the public and co-workers. This position works collaboratively with all other staff to assist the patient and facilitate successful patient interaction with the practice team. This position reflects and carries forward the mission and goals of the practice both internally and throughout the community.

I. Duties

Apply practice standing orders when performing various job functions.

A.  Referrals and Authorizations

1. Verifies patient insurance information, contacts insurance carriers to obtain authorizations for diagnostic testing. 
2. Generates diagnostic orders in EMR, faxes necessary supporting documentation along with script to testing facilities.
3. Demonstrates a clear understanding of the medical chart and has the ability to provide clear and accurate supporting clinical information as necessary to support the need for ordering tests.
4. Follows guidelines for testing, provides acceptable diagnosis for testing requested advises testing centers if diagnosis supplied for testing is non-covered and advises patient as necessary.
5. Demonstrates ability to look up and re-process prescriptions for diagnostic procedures.
6. Accurately documents clinical message in EMR, verifying spelling of name, phone number, and date of birth.  Uses last four digits of the social security number or date of birth to look patients up in EMR.
7. Demonstrates computer skills to accurately maintain provider orders based on established policies and protocols
8. Prepares supporting documentation and demonstrates the ability to print, fax and generate all required documentation necessary for referral as scheduled.
9. Demonstrates the ability to accurately determine ICD-9-cm and CPT codes for ordered tests.
10. Ensures the delivery of the Patient Centered Medical Home Standards through a care team approach.

B.  Scheduling

1. Schedules outside testing and specialists appointments as required.
2. Effectively communicates information regarding testing appointments to patients.
3. Accurately documents all communication regarding appointments in EMR telephone templates, diagnostic ordering templates, and plan templates accordingly.
4. Tasks all patient appointments to the ordering physician’s nurse for follow up.
5. Accurately manages phone request by scheduling patients, documenting the message or contacting clinical team for support when required.       
6. Follows established scheduling protocols and directs clinical concerns to appropriate provider staff member.

C.  General Expectations

1. Daily documents clinical messages in EMR based on established policy and procedures.
2. Organizes charts based on office protocol, discards items per policy.
3. Copies/faxes charts requested by outside offices.
4. Accurately inputs patient’s demographic and insurance information into computer as needed.
5. Reviews all encounter forms for accuracy.
6. Immediately responds to patients in a positive, friendly, helpful manner. 
7. Any and all other clerical duties as assigned.

D. Patient Care Environment

Demonstrates appropriate knowledge and expectations related to emergency procedures to implement in the event of the medical emergency, violence, fire, disaster or severe weather

E.  Other  

This individual is expected to assist in meeting the goals set forth by the Medical Director and Practice Administrator. This will include other duties as assigned by members of the management staff.

II. Customer Service:

• Interacts and communicates with everyone (i.e., patients, guests, staff, etc.) appropriately demonstrating respect, compassion and courtesy.
• Incorporates patient service expectations into daily practice to promote patient satisfaction.
• Accepts responsibility for meeting or exceeding their patients’ expectations.
• Identifies and accepts accountability for addressing patient service opportunities.
• Recognizes age related differences and diversity, provides care to meet those needs.

III. Professional Conduct:

• Contributes to the smooth operation of the office and demonstrates collaboration and flexibility in an effort to provide quality services.
• Maintains confidentiality and ensures department procedures comply with confidentiality standards.
• Demonstrates respect for equipment, buildings and grounds to ensure a customer-friendly environment.
• Values differences among office staff and respects the opinions, ideas and diversity of others and encourages others to do the same.
• Offers and receives constructive feedback.
• Takes initiative and steps to resolve issues and conflicts directly.
• Takes personal accountability for own actions and follows through with commitments.
• Refrain from eating or drinking in public view.
• Demonstrates professional appearance, manners and decorum

IV. Environment of Care:

•              Identifies circumstances that put patients, staff or guests at risk for experiencing accidents or injury and follows through to report or resolve danger. These factors could include, but not limited to, the following:

•              Substance abuse;

•              Behavior disorders;

•              Side effects of medications;

•              Physical impairments;

•              Wet floors, spills, uneven floor covers, etc.; and

•              Faulty equipment.

•              Demonstrates appropriate knowledge and expectations related to emergency codes and procedures to implement in the event of the medical emergency, violence, fire, disaster or severe weather.

V. Attendance/Punctuality:

• Is punctual for work as assigned, plans ahead for time off and has few unscheduled absences
• Schedules time off in advance following office policy
• Follows practice call-in procedures
• Strives to keep unscheduled absences to 5 or less per calendar year

VI. Continuous Learning:

• Demonstrates accountability for own competence and growth and seeks out appropriate resources to enhance competency and improve performance.
• Keep personal in-service record up to date.
• Attends required meetings as requested.
• Attends In House In service/training programs as scheduled
• Annual review of office policies and procedures, ensuring compliance regulation standards, including but not limited to those aligned with PPC-PCMH accreditation.

VII. Quality Performance Improvement:

• Participates as requested in quality performance projects to improve quality of the practice, including those which align with the practice’s dedicated efforts to ensure further development of our practice as a regionally and nationally recognized patient centered medical home.
• Attends all required training sessions and clinical meetings as scheduled.

VIII. Access, Use and Disclosure of Patient Information:

Position requires access to patient Protected Health Information (PHI) and individually Identifiable Health Information (IIHI) within the job responsibilities listed above. Employee is advised that inadvertent and/or intentional disclosure of this information violates Federal Law and can result in termination and/or fines.

IX. Confidentiality:

This individual is expected to maintain patient confidentiality and following all HIPAA guidelines, disclosing PHI only with appropriate parties, privately and as necessary according to company policy.

X.  Typical Physical Demand: Requires full range of body motion including occasional handling and lifting patients, manual and finger dexterity and eye-hand coordination.  Requires standing and walking for extended periods of time, stooping and bending.  Occasionally lifts and carries items weighing up to 50 pounds.  Requires corrected vision and hearing in normal range.  Requires working under stressful conditions and occasional irregular hours.  Requires some exposure to communicable diseases and body fluids.

XI. Environment:

Unpredictable demanding environment with wide variations in project development, needs and services offered, patient needs, number of patients/health care team members and internal and external customer demands.

X. Qualifications:

To perform this job successfully, this individual must understand and work well in a production-driven environment, meeting established benchmarks. This individual must understand and work well in a fast-paced and often times stressful environment. Referral and authorization clerk must demonstrate concern and empathy, providing excellent customer service while acknowledging physiological and psychological needs. To be successful, a referral and authorization clerk must have the ability to work well with others in a team environment and display sound judgment.   The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Required Qualifications: 
  • High School diploma.
  • Minimum two years experience in healthcare.
  • Proven ‘team player’ experience.
  • Demonstrated experience in computer use.
  • Understanding of insurance carrier authorization process.
  • Knowledge of current ICD-10 and CPT-4 codes
    • Desirable Qualification:
      • Demonstrated competence interpersonal and intra professional relations.    
      • Associates degree or certificate from medical assisting or secretarial school.
      • Experience in medical terminology.
      • Knowledge of NextGen practice management system.