Clinical Referral Specialist

Advocate Health and Hospitals Corporation • Grafton, WI

2d • Remote

About The Position

The Clinical Referral Specialist is responsible for reviewing work queues to identify unscheduled ordered services and connecting with patients to schedule the appropriate service. This role involves scheduling appointments, including complex specialty appointments, and adhering to appropriate protocols. The specialist communicates pre and post-appointment instructions to patients, accurately schedules medical services, and links orders to appointments. A key responsibility is providing provider referrals based on ordered services and patient preferences. The role also includes documenting all contact attempts in the patient's electronic health record, notifying ordering providers of service removals, and problem-solving to provide the highest level of patient service. Additionally, the specialist educates patients on referral and authorization requirements, payer coverage, and eligibility guidelines, and performs registration responsibilities to ensure accurate patient and payer information. Maintaining knowledge of Medicare, Medicaid, and third-party payer requirements, as well as insurance plans requiring pre-authorization, is crucial. The role may also involve obtaining and updating demographic, insurance, and financial information.

Requirements

• Typically requires 1 year 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.
• 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.
• 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.

Responsibilities

• Reviews work queues to identify unscheduled ordered services and connects with the patient to schedule the appropriate service.
• 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.
• Provides 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 adheres 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.
• Provides the highest level of patient service by problem solving, documenting patient concerns, and identifying appropriate follow-up for patients.
• Educates patients regarding referral and authorization requirements, payer coverage, eligibility guidelines, and insurance related changes or trends.
• Performs registration responsibilities to ensure accurate patient information and confirms patient payer information.
• Maintains knowledge of Medicare, Medicaid and third-party payer requirements, guidelines and policies, insurance plans requiring pre-authorization and current accepted insurance plans.
• May obtain demographic and insurance information.
• May ensure insurance and patient information obtained is complete and accurate and update information if necessary.
• May update financial information and other data when changes or additions occur, and may communicate to patients as appropriate.

Benefits

• Paid Time Off programs
• medical, dental, vision, life, and Short- and Long-Term Disability
• Flexible Spending Accounts for eligible health care and dependent care expenses
• 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: Part-time
• Career Level: Mid Level
• Education Level: High school or GED