Referral Specialist (47850)

SUMMARY: For 40 years, Care For the Homeless has fought homelessness by delivering high-quality and client-centered health care, human services and shelter to homeless individuals and families, and by advocating for policies to ameliorate, prevent and end homelessness.

This employee will work as part of the PCMH team with the following essential duties andresponsibilities:

The Referral will be responsible for (1) coordinating patient referrals (2) providing support to patients and staff.
 

• Direct referrals to specialists and track referral status
• Prioritizes referrals by their urgency and addresses them in a timely manner.
• Ensures complete demographic, insurance information and appropriate/pertaining clinical information is sent to referred specialists.
• Verify insurance information for patients, including contacting insurance companies to ensure prior approval requirements are met. Presents necessary medical information such as, history, diagnosis and prognosis to insurance companies if deemed necessary to prove medical necessity of services.
• Obtain authorization from managed care organizations (MCOs) procedure and specialty referrals.
• Report outstanding referrals to providers in a timely manner.
• Reschedule referrals as necessary and requested by the Medical Provider.
• Utilize eClinicalWorks (eCW) and EpicCareLink to manage referral process.
• Work with HHC Advantage and other referral resources to electronically submit referral requests and obtain patient results.
• Verify assignment of a CFH Primary Care Provider (PCP) and inform staff when a PCP change is needed.
• Collaborate with medical biller to confirm third party eligibility process.
• specialist serves as a point of contact for patients and specialists for any questions or rising concerns. Assist in problem solving potential issues related to their referral due to language or social barriers. 
• Performs additional duties, as needed.

Education: Bachelor's Degree required

• Experience:
  • 1-2 years of administrative or clinical experience in a medical setting preferred.
  • Familiarity with ICD Codes, Affordable Care Act and MCOs.

· Skill Sets:

• Excellent organizational and communication skills required
• Attention to detail
• Ability to multi-task and meet assigned deadlines from a variety of management staff
• Ability to work in a fast-paced and ever-changing environment
• Leadership and/or facilitation experience with a group or team
• Public presentation and speaking sills
• Proficient in Microsoft Office Suite with ability to create:
  • Create, edit and interpret charts, tables, and spreadsheets
  • Effectively manager, filter and sort data
  • Create well-organized documents and outlines