Job Description

Min

USD $16.50/Hr.

Max

USD $24.82/Hr.

• Full time
• Day shift

The Referral Management Specialist I reports to the Manager of Ambulatory Care Management. Under general supervision, the Referral Management Specialist I will utilize tools designed to facilitate the referral process and schedule appointments for multiple specialties for Memorial Care primary care patients. Working primarily in an office setting, the Referral Management Specialist I will partner with the Primary Care Physician team to provide a resource for timely referrals that will increase clinical and operational processes which will positively impact patient safety and quality. The Referral Management Specialist I 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 Referral Management Specialist I will follow all applicable regulations, policies, and guidelines to ensure compliant and appropriate management of patient referrals to specialty care.

Qualifications

Education:

• High school diploma required

Licensure/Certification/Registry:

• Certified Nursing Assistant (CNA) through state of Illinois or two years previous experience in a Primary Care Physician medical office or clinical setting required.

Experience:

• Previous clerical and EHR documentation experience preferred-specifically Allscripts EHR

Other Knowledge/Skills/Abilities:

• Strong knowledge of local physician networks and their associated specialties, including Springfield Clinic, 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

Responsibilities

• SAFETY: Prevent Harm - I put safety first in everything I do. I take action to ensure the safety of others.

• COURTESY: Serve Others - I treat others with dignity and respect. I project a professional image and positive attitude.

• QUALITY: Improve Outcomes - I continually advance my knowledge, skills and performance. I work with others to achieve superior results.

• EFFICIENCY: Reduce Waste - I use time and resources wisely. I prevent defects and delays.

The intent of this job description is to provide a representative summary of the major duties and responsibilities performed by incumbents of this job. Incumbents may be requested to perform tasks other than those specifically presented in this description.