Referral Specialist 282 views9 applications
- Salary Offer Commensurate with Experience
- Experience Level Entry Level
- Total Years Experience 1-2
- Education High School Diploma
Trillium Health, a Federally Qualified Health Center Look-Alike, is a community health center offering access to affordable care for all, with a special focus on meeting the needs of LGBTQ people, communities of color, and underserved populations.
Nationally recognized for outstanding patient-centered care, the team at Trillium Health provides a wealth of knowledge and experience. Our expansive array of services, including testing and treatment, laboratory services, primary and specialty care, and an on-site pharmacy, makes it easier for patients and clients to receive the complete care they need, all in one place.
Our authentic commitment to diversity and inclusion is evidenced through our hiring practices, our employee programs, and our compassion for everyone we serve. Based in downtown Rochester, with satellite locations in Bath and Geneva, and MOCHA centers in Buffalo and Rochester, Trillium is deeply invested in building community. We proudly sponsor many other nonprofit organizations throughout the area and participate in a wide range of community events.
Trillium’s employee-centered company culture and exceptional benefits have contributed to impressive growth in recent years, raising our staff total to more than 250. We hope you will consider joining us on this upward path and becoming a part of the Trillium Health family.
We are currently recruiting for a Referral Specialist.
- Assign the patient to the appropriate specialty provider or facility based on the patient’s current medical needs as defined by the primary care provider.
- Provide all the required medical history information regarding the patient to the specialty provider or facility.
- Determination of primary responsibilities for the medical bill and identifying any changes made by the clients or payers.
- Coordinate with insurance carriers and specialty practices to obtain prior authorizations, pre certifications ad referrals on applicable plans which include HMO, PPO and POS health plans and documents all benefit information into the patients’ electronic medical record.
- Coordinate and communicate with Care Managers and other departments to facilitate the financial counseling and other insurance issues.
- Ensure that patient’s financial counselor is aware of any copayments, deductibles, etc.
- Fax medical documentation as needed and requested by clinical staff and outside agencies.
- Keep both the patient/client and the corresponding provider informed of scheduled details such as day/time and place of visit.
- Assist in providing information to the patient/client on any preparation required before the visit.
- Inform the specialty provider or facility of any special needs for the patient such as interpreters, transportation, escort, etc.
- Enter all the referral information into the electronic medical record system.
- Contact patient, specialty provider or facility to reschedule missed appointments for patients if applicable.
- Schedule any pre and post follow up appointments with the medical or specialty provider if applicable.
- Obtain all labs, radiological, surgical and other medical reports from the specialty provider or facility to ensure continuity of care.
- Send all pertinent information to the referred organization.
Referral Tracking and Quality Reporting
- Keep track of patient/client referrals in the system and follows up with clients who have missed referral appointments.
- Maintain an accurate up-to-date monthly report of scheduled patient offsite appointments.
- Run and monitor a weekly crystal report to capture any missed referrals made by the providers.
- Track and maintain a “No Show” report for offsite appointments and informs the providers, care managers and other staff if applicable.
- Maintain any quality reports required to meet Patient Centered Medical Homes, Meaningful Use and Health Homes requirements.
- Follow up with facilities for patient/client information.
- Requires the ability and commitment to respect and support inclusiveness and diversity including but not limited to individuals of different backgrounds, cultures, races, ages, sexual orientations, gender identities or expressions, experiences, opinions, etc.
- Requires individual demonstration of commitment to the One Trillium behaviors and business impacts and modeling them in the organization.
- Responsible for maintaining confidentiality of all patient, client, employee, protected and proprietary information.
- Employees are accountable for meeting the performance standards of their departments and must participate as requested in compliance audits, process improvement and quality improvement plans.
- Other specific duties as assigned.
High School diploma or GED required with a minimum of 2 years recent insurance verification, referrals and prior authorization experience in a medical office or clinic is required. Associate’s degree preferred in Health Education, Health and Human Services.
Excellent verbal and written communication skills, good typing and computer skills. Excellent customer service skills, team player and positive attitude. Ability to make decisions and solve problems. The ability to speak, read or write a foreign language is desirable.
Trillium Health offers employment to all employees & applicants. No person shall be discriminated against in employment on the basis of race, age, color, marital status, religion, creed, sex, sexual orientation, gender identity or expression, national origin or ancestry, disability, veteran status, status as a domestic violence victim, genetic condition or predisposition, or any other characteristic protected by law.