Referral / Medical Records Specialist

Roosevelt General Hospital•Portales, NM

About The Position

Under general supervision, the Referral/Medical Records Specialist is responsible for supporting patient care coordination and health information management functions at RGH Clovis Clinic by way of processing referrals, medical record scanning, and providing phone and registration coverage. This position serves as a key point of contact for patients, families, providers, and external healthcare partners while ensuring accurate management, processing, and release of patient medical records. The Referral/Medical Records Specialist coordinates patient referrals and obtains prior authorizations for diagnostic services and procedures while assisting patients in navigating services both within RGH Clovis Clinic and with outside providers. In addition, this position ensures medical records are accurately retrieved, scanned, indexed, analyzed, and maintained in compliance with hospital policies and all applicable state and federal regulations, including HIPAA. This role supports patient access to care, protects the integrity and confidentiality of health information, and assists in ensuring medical records are complete and available to support quality patient care, regulatory compliance, and accurate reimbursement. The Referral/Medical Records Specialist embodies the mission, vision, and values of Roosevelt General Hospital & Clinics while providing excellent customer service and administrative support.

Requirements

High school graduate or equivalent.
General computer knowledge.
Adhere to dress code, appearance is neat and clean.
Complete annual education requirements.
Maintain patient confidentiality at all times.
Report to work on time and as scheduled.
Wear identification while on duty.
Maintain regulatory requirements, including all state, federal and local regulations.
Represent the organization in a positive and professional manner at all times.
Comply with all organizational policies and standards regarding ethical business practices.
Communicate the mission, ethics and goals of the organization.
Participate in performance improvement and continuous quality improvement activities.
Attend regular staff meetings and in-services.
Knowledge of health information management services
Must have an enthusiastic and positive attitude
Possess a genuine desire to help RGH become an exemplary hospital in the surrounding community and the state
Ability to work independently, exercise creativity, be attentive to detail, and maintain a positive attitude
Ability to manage multiple and simultaneous responsibilities and to prioritize duties/tasks Ability to initiate communication with patients, their families and hospital visitors
Must have excellent customer service and communication skills with the ability to effectively calm patients and be able to deal with distressed and/or agitated patients and their families
Must have a professional demeanor and excellent public relations skills
Willingness to develop or improve public speaking skills
Must have excellent written skills with knowledge of medical terminology
Must be dependable and on time
Possess good 'people skills' for building relationships with colleagues at all levels
Ability to plan and prioritize workload to meet deadlines

Nice To Haves

Previous hospital experience preferred.

Responsibilities

Promote the mission, vision, and values of the organization.
Greet patients, families, and visitors in a professional and courteous manner and assist them in navigating hospital and clinic services.
Perform patient registration functions including collecting and verifying demographic information, insurance information, and required documentation.
Verify insurance eligibility and ensure patient information is accurate within the electronic medical record (EMR) system.
Explain required registration forms, obtain appropriate signatures, and ensure completion of required patient documentation.
Coordinate incoming and outgoing patient referrals to internal departments and external providers.
Obtain prior authorizations for diagnostic services, procedures, and specialty services as required by insurance providers.
Schedule referral appointments and notify patients of appointment details.
Serve as a liaison between patients, providers, departments, and external healthcare partners regarding referrals, authorizations, registration, and medical record requests.
Conduct follow-up communication with outside providers to confirm appointments and obtain consultation reports when applicable.
Maintain competency in obtaining, entering, retrieving, and updating patient information within electronic medical record and information systems.
Maintain strict confidentiality and safeguard protected health information in compliance with HIPAA regulations.
Perform document management activities including batching, scanning, indexing, quality review, and releasing documents to the legal medical record.
Conduct medical record analysis to insure documentation is complete and accurate before scanning.
Monitor medical records for prompt completion to support documentation, coding, and reimbursement processes.
Utilize software systems for ICD and CPT coding when required for referrals or documentation processes.
Answer departmental phone calls, respond to voicemails within 24 hours (excluding weekends), and relay messages to appropriate staff.
Provide general information regarding RGH services and assist patients in accessing appropriate care.
Retrieve documentation from hospital departments and affiliated clinics as needed.
Perform system support functions including password management, adding or modifying user profiles, managing document types, adjusting document indexes, maintaining record review groups, monitoring workflow queues, managing workflow permissions, and supporting printing, faxing, and email maintenance.
Maintain accurate documentation and records in accordance with hospital policies and regulatory requirements.
Establish and maintain positive working relationships with hospital departments, providers, and external healthcare partners.
Provide excellent customer service to patients, staff, and external partners.
Assist other members of the department as needed to support efficient operations.