Patient Access Specialist - Referral Specialist

Under general supervision, the PAS Referral Specialist will utilize tools designed to facilitate the referral process and schedule appointments for multiple specialties for Springfield Clinic patients. Working primarily in an office setting, the PAS Referral Specialist will partner with the Springfield Clinic clinical teams to provide a resource for timely referrals that will increase clinical and operational processes which will positively impact patient safety and quality. The PAS Referral Specialist will ensure timely arrangement of appointments at specialty clinics, ensure primary care provider preferences are met, when possible, ensure payer requirements for referrals are met, complete necessary payer prior authorizations, and communicate appointment details to patients, primary care providers, and specialty offices. The PAS Referral Specialist follows all applicable regulations, policies, and guidelines to ensure compliant and appropriate management of patient referrals to specialty care.

Job Relationships

Reports to the Operations Manager

Principal Responsibilities.

• Responsible for working referrals based on various specialty procedures.
• Interacts with patients in a professional manner displaying courtesy and the ability to inform patient on procedure they will be receiving.
• Responsible for obtaining necessary referrals for patients in need of ancillary or specialty services. Maintains documentation accordingly and provides authorization codes and numbers to patients. Works directly with patients regarding the requirements and limitations of their health plan.
• Accountable for improving provider efficiency and effectiveness by performing referral process; allowing the care teams to spend more time with patient care.
• Displays ability to understand insurance coverage and how to obtain pre-authorization for procedures.
• Faxes copies of medical records to insurance companies, managed care companies and physicians' offices to ensure that the patient's referral will be a covered service, and that the recipient physician is prepared for the visit.
• Maintains key contacts at insurance care companies, documenting all interactions, helping to facilitate referral process.
• Acts as a primary contact when change is forthcoming with insurance coverages.
• Functions under the direction of the Supervisor, Referral Management and referring Providers
• Must operate effectively with various levels of leadership and clinical expertise, while assisting with accomplishing department goals and objectives.
• Assists team members with completion of duties in a timely and accurate manner while being able to function independently with assigned duties.
• Maintains accurate and timely documentation and follows up when applicable.
• Interacts with co-workers, visitors, physicians and other healthcare personnel in a manner that enhances service delivery and promotes positive relationships.
• Adheres to all HIPAA guidelines and patient confidentiality policies. Applies the minimum necessary standard when accessing protected health information.
• Comply with the Springfield Clinic incident reporting policy and procedures.
• Adhere to all OSHA and Springfield Clinic training & accomplishments as required per policy.
• Provide excellent customer service and adhere to Springfield Clinic's Code of Conduct and Ethics Standards.
• Perform other job duties as assigned.

Education/Experience

• High School graduate or GED preferred.
• Comfortable with technology.
• Preferred: Administrative or technical background acquired through completion of 2-3 years of college.
• Preferred: Minimum one (1) year medical office experience

Knowledge, Skills and Abilities

• Previous clerical and EHR documentation experience preferred-specifically Allscripts and/or Athena.
• Strong knowledge of local physician networks and their associated specialties, including Springfield Clinic, MPS, SIU, OCI, Prairie and others.
• Strong general computer skills in Microsoft Office; especially Microsoft Excel spreadsheets, databases, and reporting tools strongly preferred.
• Working knowledge of insurance requirements and coverage.
• Understanding of insurance prior authorization processes and insurance referrals.
• Possesses strong medical terminology.
• Demonstrates understanding of evidence-based healthcare.
• Demonstrates ability to work in a fast changing and ambiguous environment.
• Engaging service-oriented skills required.
• Excellent organizational skills required. Demonstrates ability to be flexible and function in stressful situations.
• Excellent oral, written communications and interpersonal skills required.
• Demonstrates initiative, self-direction, and motivation.
• Demonstrates open/global communication skills with multiple requesters.
• Ability to work with multiple care providers and maintain positive working relationships.

Working Environment

• Office type environment requiring frequent fluctuations between sitting and standing.

PHI/Privacy Level

HIPAA1