Referral Specialist

Saint Francis Health System•Remote - OK, OK

2d•Hybrid

About The Position

The Referral Specialist will review, analyze and document all referral requests, obtain appropriate authorizations for all plans (managed care, Medicaid, Medicare) and coordinate the scheduling of the “referred to” specialty including communication with the Specialty Office and Patient. This role involves daily queue analysis to prioritize work for optimal patient scheduling, research of referral documentation, and ensuring adherence to departmental protocols for consistency in Epic documentation and communication. The specialist will also coordinate appointment scheduling with specialty staff/offices and diagnostic locations, communicate appointment details to patients, and track referral queue aging to report on patient care accessibility. Additionally, the role includes identifying specialty physicians, maintaining reference information, answering patient calls to match them with new physicians based on location, insurance, and medical needs, and serving as a contact point for Warren Clinic office staff regarding referral status and inquiries. The position requires ensuring that questions, potential delays, and changes are escalated to supervisors for support. Decision-making involves carrying out non-routine procedures under changing conditions according to general supervisor instructions. Working relationships include direct interaction with patients, internal and external customers via telephone or face-to-face, other healthcare professionals, and frequent interaction with individuals at the Director level or above.

Requirements

High School Diploma or GED.
3 - 4 years related experience.
PC skills.
Customer service skills.
Organizational skills.
Communication skills.

Nice To Haves

Previous EPIC experience.
Previous Medicaid/Medicare experience.

Responsibilities

Review, analyze, and document all referral requests.
Obtain appropriate authorizations for all plans (managed care, Medicaid, Medicare).
Coordinate the scheduling of the “referred to” specialty.
Communicate with the Specialty Office and Patient regarding referrals and appointments.
Analyze daily queue to prioritize work for optimal scheduling of patients.
Research referrals to determine if all necessary documentation is included.
Assist in obtaining authorization if required for payment.
Follow departmental protocols to ensure consistency in documentation in Epic and communication.
Work with partners to ensure daily coverage.
Arrange appointment dates and times with specialty staff/offices and diagnostic locations.
Communicate appointment information to patients.
Document appointment information for PCP office to ensure referral completion.
Perform weekly and monthly accounting of referral queue aging to review and provide information about accessibility of patient care by specialty.
Locate specialty physicians and maintain desktop reference information relating to assigned specialty.
Answer telephone calls from patients seeking new physicians.
Determine patient match based on geographic area, insurance, and presenting medical problem(s).
Serve as a contact point for Warren Clinic office staff with 'same day' referral questions and inquiries about patient referral status.
Ensure that questions, potential delays and changes are brought to the attention of supervisor and/or manager.