Patient Access Referral Specialist I (3591)

REGIONAL ONE HEALTH•Memphis, TN

1d•Onsite

About The Position

The Outpatient Patient Access Referral Specialist coordinates all patient referrals made by Providers to appropriate specialties or for diagnostic services. Obtains and documents in patient records, receipt of certification and authorization from Third Party reimbursement companies (MCOs, HMOs, PPOs). Ensures providers have test results available in a timely manner. Completes follow-up referrals.

Requirements

High School Graduate or equivalent with related course work.
At least 1 year experience Twelve (12) months clerical or completion of a clerical training program

Nice To Haves

Experience in authorizing referrals

Responsibilities

Collaborates with providers regarding patient diagnosis and need for referral.
Obtains all relevant patient information needed to make referral and obtains pre certification and/or authorization from appropriate MCOs/insurance agency.
Ensures proper ICD or CPT coding is completed on Referral Form. Ensures completeness of referral documentation form by provider.
Investigates appointment schedules and coordinates with patients regarding their availability and scheduling needs and in accordance with available appointment openings at specialties. Ensures appointment schedules are coordinated within established guidelines set by contracting agencies. Patient Appointment Reminder System.
Arranges for patient transportation prior to appointment.
Contacts Third Party Reimbursement/Certification Departments to obtain authorization for referral. Documents all communication on Referral/Certification Form and enters data into computerized referrals program.
Ensures completeness of all patient data/demographic information. Forwards necessary documentation to referring physician/diagnostic service.
Ensures that reports from consulting physicians, discharge summaries, diagnostic reports, etc. are received, reviewed and signed within two (2) weeks following appointment and filed appropriately.
Pending reports/results are followed up with referring agency and/or patient as appropriate. No show or rescheduled appointments are reported to the provider and documented in the patient’s chart on the referral form, along with the date of entry and the initials of the referral clerk.
Collaborates with the Community Outreach Coordinator regarding patient care follow-up and satisfaction level as it relates to referral.