Summary:
Responsible to coordinate and complete specialty and diagnostic services in a timely and efficient manner. This position is also responsible for tracking the receipt and completion of specialty and diagnostic referrals including but not limited to phone calls and letters to non-compliant patients.
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Essential Duties and Responsibilities:
- Coordinate all aspects of a specialty and/or diagnostic referral in a timely manner when requested by Grace Health providers.
- Verify insurance coverage and obtain prior authorizations for services to be rendered as required by individual insurance plans.
- Ensure that the specialist accepts the patient’s insurance plan.
- Assemble referral paperwork and requested medical information and submit to the specialty office as needed.
- Communicate referral information to the patient and providers.
- Document appointment or preauthorization information in Nextgen EMR or in an electronic log of all referrals.
- Provide excellent customer service to both internal and external customers.
- Establish and maintain professional relationships with all staff.
- Inform leadership of authorization or referral concerns, back logs, or insurance issues.
- Routinely generate a NextGen Referral report or work electronic log of ordered referral requests.
- Verify that the office has received the diagnostic or specialty report when ordered.
- Coordinate with appropriate sites to obtain diagnostic results or specialty referral report if the information has not been received.
- Complete the referral order in the Order Management section of Next Gen or indicate complete on the electronic log indicating the date that the referral results were received.
- Conduct patient outreach when the patient has not been compliant with a provider’s order; one phone call and one sent letter.
- Document patient’s non-compliance in Next Gen Order Management section and Manage Selected Referral or on the electronic log.
- Work with other members of the health team when patients request that their referral be rescheduled.
- Other duties may be assigned.
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Other Essential Duties and Responsibilities:
- Grace Health recognizes that managing patient care is a team effort involving both clinical and non-clinical staff. All employees must embrace a team-based approach to patient care and understand that each role is important to our success.
- Team members must demonstrate excellent communication and coordination skills to provide quality patient care.
- Care coordination includes communication with community organizations, health plans, facilities, and specialists.
- Care team members must understand and embrace the concept of population health management and proactively address the needs of patients and families served by the practice.
- Team members must demonstrate the skills and knowledge necessary to communicate effectively with vulnerable patient populations.
- Team members must participate in Continuous Quality Improvement (CQI) activities within the organization to ensure patients receive high-quality care.
- All team members will be involved in improving quality outcomes.
- Team members will participate in the review and evaluation of practice performance and help identify opportunities for improvement.
- Team members will participate in Grace Health's advocacy program.
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General Duties:
- Follows all organizational policies and procedures, including administrative, clinical, quality assurance, and personnel policies.
- Maintains satisfactory attendance, including attendance at meetings and completion of assigned tasks.
- Maintains timely documentation of all work assignments.
- Maintains patient confidentiality.
- Routinely keeps the supervisor informed regarding attendance and job assignments.
- Demonstrates flexibility and the ability to multitask.
- Works effectively and efficiently.
- Works cooperatively with providers, administration, and peers.
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Qualification Requirements:
To perform this job successfully, an individual must be able to support and advance Grace Health's mission while satisfactorily performing each essential duty. The requirements listed below represent the knowledge, skills, and abilities required for the position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the job.
Skills:
- Pleasant personality and professional demeanor
- Cooperative attitude-Flexible
- Detail Oriented
- Able to work with minimal supervision
- Highly organized work habits with ability to prioritize
- Intermediate computer skills with Microsoft Word and Excel
- Familiar with Electronic Medical Record
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Education and/or Experience:
Must have completed high school or equivalent. Must have past experience with Referrals and Authorizations. Prefer 1 year Medical Office experience. Prefer RMA or CMA.
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Physical Demands:
The physical demands described herein represent those that must be met by an employee to perform the essential functions of this job successfully. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.
While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to stand, walk, sit, and use hands to finger, handle, or feel objects, tools, or controls. The employee occasionally is required to reach with hands and arms, stoop, kneel, crouch, or crawl, and taste or smell.
The employee must occasionally lift and /or move up to 50 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.
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Work Environment:
Grace Health is a faith-based, federally qualified health center (FQHC). We provide primary healthcare services to underserved, underinsured, and uninsured individuals throughout southeastern Kentucky. Our mission is "to show the love and share the truth of Jesus Christ to southeastern Kentucky through access to compassionate, high-quality primary healthcare for the whole person."
The work environment characteristics described herein are representative of those an employee encounters while performing the essential functions of this position. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions of the position.
The noise level in the work environment is typically moderate.
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Grace Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
