Transfer & Referral Specialist Lead

Sutter Health•Sacramento, CA

3d•$42 - $64

About The Position

Responsible for assisting with assigning work to staff and supporting day-to-day operations. Provides functional guidance and direction to staff, maintains department statistics, and ensures established turnaround times are met. Reviews daily referral-pool volumes and distributes work accordingly. Reviews and researches policies and procedures and makes recommendations for updates to improve referral and authorization processing. The role performs referral-entry functions, monitors and resolves referral and authorization orders, reviews urgent and pending referrals, and helps ensure timely service and customer support. It receives referral-related calls, gathers clinical and insurance information, identifies appropriate services or specialists, and reviews confidential clinical information to determine available services within the medical network. It facilitates referrals in accordance with payer rules, specialist capacity, and contractual relationships, and assists clinicians with challenging or complex specialty referrals. The lead supports staff through workload coordination, training, mentoring, and guidance; serves as an escalation point for patient and provider inquiries; assists with policy and procedure updates and error reviews; and helps resolve planning issues. The position manages multiple projects, monitors work queues for bottlenecks and delays, communicates with referral sources, specialists, physicians, and affiliate staff, and responds to inquiries professionally and promptly. It also contributes to performance feedback, coaching, process improvement, problem solving, and effective working relationships.

Requirements

Bachelor’s degree in Business, Healthcare Administration, or a related field; equivalent experience is accepted in lieu of the required degree or diploma.
Four years of recent relevant experience.
Working knowledge of managed care requirements and processes.
Knowledge of system, affiliate, and community resources and third-party payers, including PPO, HMO, Medicare, and insurance plans.
Knowledge of insurance authorization processes and HIPAA requirements.
Familiarity with medical and managed-care terminology.
Understanding of disease processes to assess referral requests and appropriate levels or providers of care.
Ability to define issues, collect data, establish facts, and draw valid conclusions.
Customer-service focus in decisions and actions.
Ability to communicate verbally and in writing and present information to varied audiences.
Organizational skills to manage and reprioritize activities and projects, meet deadlines, and remain responsive.
Ability to interact effectively and maintain working relationships with people contacted in the performance of duties.
Ability to respect cultural and linguistic differences and promote an inclusive work environment.
Initiative in providing feedback and input to improve workflows and processes.
Ability to work effectively in a dynamic, fast-paced environment with changing priorities.
Ability to handle confidential and sensitive information discreetly.
Ability to use essential applications and databases associated with the role.

Responsibilities

Perform all referral-entry tasks and functions.
Monitor and resolve referral and authorization orders in a timely manner.
Monitor urgent and pending referrals to ensure timeliness standards and customer service expectations are met.
Receive calls, collect clinical and insurance information, and identify appropriate services, programs, or specialists for referral requests.
Assign daily workloads and monitor referrals, call queues, and fax boxes.
Review confidential clinical information and determine whether requested services are available within the medical network.
Identify system specialists and programs and facilitate referrals in accordance with payer rules, specialist capacity, and contractual relationships.
Assist clinicians with challenging or complex specialty referrals.
Assist the manager with day-to-day staff workload assignments by reviewing referral volumes and distributing work.
Provide functional guidance, training, and mentoring to new and existing staff.
Escalate and address patient and provider inquiries concerning turnaround times that do not meet standards.
Research and recommend modifications to policies and procedures.
Review errors submitted by staff or patients and errors identified through audits.
Assist stakeholder groups in resolving less complex planning issues.
Manage multiple projects, including facilitating meetings and establishing work plans and timelines.
Use work-queue management and tracking to identify bottlenecks and referral delays.
Meet with referral sources to ensure they understand processes.
Communicate with specialists and physicians to maintain current information on clinical procedures, capabilities, fee schedules, and contracting arrangements.
Communicate with affiliate staff to maintain an understanding of entity service capabilities.
Respond promptly and professionally to emails, customer concerns, and escalated referrals.
Prepare and present less complex projects to senior leadership.
Provide and respond to performance feedback, including coaching staff.
Support the team and contribute ideas and actions to improve processes and workflows.
Recognize and communicate potential issues to the appropriate leader.
Build effective relationships with customers, peers, colleagues, and leaders, and take initiative in department and project teams.
Use analytics and problem-solving skills and take responsibility for portions of deliverables with management oversight.