Referral Specialist

Brown Medicine•Cranston, RI

1d•$19 - $31•Onsite

About The Position

The Referral Specialist reports to a Patient Access Manager and, under general supervision, ensures the quality of the referral process in accordance with departmental standards. The role evaluates incoming referrals for accuracy and whether the information appropriately reflects the patient’s symptoms and requested treatment. The specialist coordinates the efficient processing and scheduling of incoming referrals, follows established timelines and procedures, and reviews monthly standard reports to monitor referral accuracy and timeliness. Employees are expected to model Brown University Health’s values of Compassion, Accountability, Respect, and Excellence, and demonstrate the core Success Factors: Instill Trust and Value Differences, Patient and Community Focus, and Collaborate. The position works in a typical medical office setting and requires extensive sitting, standing, and walking. The specialist reads referrals for new patient appointments for much of the day and must be able to work in a fast-paced, sometimes stressful environment while meeting productivity and accuracy metrics. The listed schedule is Monday through Friday, 8:30 a.m. to 5:00 p.m., with an eight-hour workday. The role is based at Rhode Island Hospital, 593 Eddy Street, Providence, Rhode Island.

Requirements

High school degree or equivalent experience.
Two years of clinical referral experience, or at least one year of related coding/billing and medical record operations experience in an ambulatory care facility Health Information/Medical Record Department.
Familiarity with and understanding of medical record content.
Strong organizational skills and demonstrated ability to prioritize, adapt to frequent workload changes, and manage competing priorities.
Excellent customer service and communication skills, including the ability to discuss delicate matters with patients and referring providers.
Knowledge and skills necessary to provide care to patients across the lifespan, considering aging processes, human development stages, and cultural patterns.
Ability to work in fast-paced, sometimes stressful conditions while meeting productivity and accuracy metrics.

Nice To Haves

Spanish speaking is strongly preferred.

Responsibilities

Receive and review incoming referrals for completeness and accuracy, including patient demographics, insurance, and authorizations.
Promptly communicate insurance coverage issues to referring providers and/or patients so patients can seek timely services elsewhere when needed.
Evaluate referrals and triage them according to established clinic guidelines; determine whether clarification or management escalation is needed.
Return incomplete or non-compliant referrals to referring physician offices with the reason for return.
Monitor referral accuracy and timeliness through monthly standard reports and perform to benchmarks for accuracy, productivity, quality, and customer service.
Communicate accurately and promptly with patients, referring providers, and other staff.
Coordinate and guide Outpatient Service Representatives or other staff on proper documentation in referral records.
Support staff with entering external referral information into the electronic health record, including demographics, reason for referral, and insurance and authorization information.
Scan faxed and paper referrals into the appropriate section of the referral record and document communications in the electronic health record.
Respond to calls about pending referrals and return voicemail messages in a timely manner.
Coordinate scheduling of referral appointments according to practice protocols, including appointments requiring prior authorization.
Keep current on insurer referral and authorization requirements and maintain understanding of the patient population with cultural awareness and sensitivity.
Schedule appointments according to triage guidelines; update demographics, verify insurance, and obtain authorizations.
Notify patients of appointments and explain preparation requirements in a manner they can understand.
Communicate with referring providers and document communications in the electronic health record, including when patients decline or miss appointments.
Refer patients to the Patient Financial Advocate when necessary.
Serve as a liaison and resource for patients, referring providers, community providers, and practice team members regarding referral issues.
Monitor clinic schedules to maximize scheduling and fill available appointment times, including times opened by cancellations or rescheduling.
Notify the provider and/or manager when a referral cannot be scheduled, an appointment must be rescheduled because of missing referral information or authorization, or other access issues arise.
Monitor referral work queues and ensure referrals are processed appropriately.
Perform other assigned duties, including reviewing the denials queue, resolving denials, and reporting discrepancies and trends to the manager.