Clinical Referral Specialist Lead

American Addiction Centers • South Milwaukee, WI

8d • $24 - $36

About The Position

Oversees the daily activities of the staff to ensure department standards are met and department policies and procedures are followed. Identifies staffing needs and communicates those needs to department leadership. In conjunction with manager, develops staff schedules, prioritization and work assignments to allow for optimal use of staff time, achievement of operating indicators and monitoring of work in progress. Responsible for department staff orientation; may develop, plan and/or administer additional staff training opportunities based on department needs. Provides the highest level of patient service by problem solving, documenting patient concerns, and identifying appropriate follow-up for patients. Performs registration responsibilities to ensure accurate patient information and confirms patient payer information. Educates patients, clinical caregivers, and providers throughout the system regarding referral and authorization requirements, payer coverage, eligibility guidelines, and insurance related changes or trends. Maintains knowledge of the following and the associated reference material; Medicare, Medicaid and third-party payer requirements, guidelines and policies, insurance plans requiring pre-authorization and current accepted insurance plans. Partners with provider practices and onsite clinical operations to coordinate efforts to successfully complete service-to orders. Reviews work queues to identify unscheduled ordered services and connects with the patient to schedule the appropriate service. Confirms and secures authorization or required pre-certifications for patients to receive specialty consultation or medical services, and closes the referral if an authorization is not required. Schedules appointments including complex specialty appointments and adheres to appropriate protocols. Communicates to the patient all pre and post appointment instructions (i.e., medication guidelines, food/beverage consumption guidelines, check in procedures, directions to facilities, etc.). Schedules the ordered medical service accurately and links order to appointment. Responsible for providing provider referrals for both internal or external order to patients based on the ordered medical service and patient’s preferences as well as the coordination of care with non-aurora specialists in accordance with Medical Group guidelines. Partners with provider practices to coordinate efforts to successfully complete service-to orders. Responsible for providing provider referrals to patients based on the ordered medical service and patient’s preferences. Documents all contact attempts to schedule the ordered medical service in the patient’s electronic health record and adhering to department workflows and procedures for contact attempts. Notifies the ordering provider through telephone encounter in electronic health record when an ordered medical service is removed according to the department’s assigned removal reasons. Responsible for management and oversight of EPIC In-Basket and pool messages as well as interdepartmental communication to caregivers regarding the management of requested authorizations across the system to include special requests (ex. Vision Therapy or authorization needed verification requests). Provides weekly/timely updates to department leadership on issues and resolution solutions to include escalation of in-house provider or caregiver questions, requests or concerns regarding the status of a patient’s ordered service or care coordination and areas of opportunity or clarification with the entire department. Assists with human resources responsibilities for staff, which may include interviewing and selection of new employees, staff development, performance evaluation feedback, resolution of employee concerns, and employee morale.

Requirements

• High School Graduate.
• Typically requires 3 years of experience in a medical group with focused experience in the coordination of patient care including scheduling of specialty services and comprehensive understanding of medical terminology and 1 year of experience as a Clinical Referral Specialist.
• Knowledge of clinical processes and procedures. Including a good working knowledge of medical terminology and medical chart documentation.
• Knowledge of patient focused software systems, (i.e. EPIC & Interactive Intelligence (I3)).
• Ability to efficiently enter/update database records and read/comprehend patient records.
• Superior knowledge of referral management and electronic health record software system with the ability to help fellow team members attain a similar level of expertise.
• Performs at a high level continuously surpassing personal goals while demonstrating strong problem-solving skills and an optimistic attitude.
• Excellent communication skills and the ability to communicate professionally and effectively with patients, peers, and caregivers across the organization.
• Demonstrated ability to work independently and be self-directed.
• Proficiency in Microsoft Office.
• Ability to manage multiple tasks.
• Excellent customer service skills.
• Supports a department culture of respect, honesty, strong work ethic and commitment to providing outstanding patient care in a positive environment.

Responsibilities

• Oversees the daily activities of the staff to ensure department standards are met and department policies and procedures are followed.
• Identifies staffing needs and communicates those needs to department leadership.
• In conjunction with manager, develops staff schedules, prioritization and work assignments to allow for optimal use of staff time, achievement of operating indicators and monitoring of work in progress.
• Responsible for department staff orientation; may develop, plan and/or administer additional staff training opportunities based on department needs.
• Provides the highest level of patient service by problem solving, documenting patient concerns, and identifying appropriate follow-up for patients.
• Performs registration responsibilities to ensure accurate patient information and confirms patient payer information.
• Educates patients, clinical caregivers, and providers throughout the system regarding referral and authorization requirements, payer coverage, eligibility guidelines, and insurance related changes or trends.
• Maintains knowledge of the following and the associated reference material; Medicare, Medicaid and third-party payer requirements, guidelines and policies, insurance plans requiring pre-authorization and current accepted insurance plans.
• Partners with provider practices and onsite clinical operations to coordinate efforts to successfully complete service-to orders.
• Reviews work queues to identify unscheduled ordered services and connects with the patient to schedule the appropriate service.
• Confirms and secures authorization or required pre-certifications for patients to receive specialty consultation or medical services, and closes the referral if an authorization is not required.
• Schedules appointments including complex specialty appointments and adheres to appropriate protocols.
• Communicates to the patient all pre and post appointment instructions (i.e., medication guidelines, food/beverage consumption guidelines, check in procedures, directions to facilities, etc.).
• Schedules the ordered medical service accurately and links order to appointment.
• Responsible for providing provider referrals for both internal or external order to patients based on the ordered medical service and patient’s preferences as well as the coordination of care with non-aurora specialists in accordance with Medical Group guidelines.
• Partners with provider practices to coordinate efforts to successfully complete service-to orders.
• Responsible for providing provider referrals to patients based on the ordered medical service and patient’s preferences.
• Documents all contact attempts to schedule the ordered medical service in the patient’s electronic health record and adhering to department workflows and procedures for contact attempts.
• Notifies the ordering provider through telephone encounter in electronic health record when an ordered medical service is removed according to the department’s assigned removal reasons.
• Responsible for management and oversight of EPIC In-Basket and pool messages as well as interdepartmental communication to caregivers regarding the management of requested authorizations across the system to include special requests (ex. Vision Therapy or authorization needed verification requests).
• Provides weekly/timely updates to department leadership on issues and resolution solutions to include escalation of in-house provider or caregiver questions, requests or concerns regarding the status of a patient’s ordered service or care coordination and areas of opportunity or clarification with the entire department.
• Assists with human resources responsibilities for staff, which may include interviewing and selection of new employees, staff development, performance evaluation feedback, resolution of employee concerns, and employee morale.

Benefits

• Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including:
• Compensation Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training Premium pay such as shift, on call, and more based on a teammate's job Incentive pay for select positions Opportunity for annual increases based on performance
• Benefits and more Paid Time Off programs Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability Flexible Spending Accounts for eligible health care and dependent care expenses Family benefits such as adoption assistance and paid parental leave Defined contribution retirement plans with employer match and other financial wellness programs Educational Assistance Program

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED
• Number of Employees: 11-50 employees