Referral Specialist

Job Description

Job Description

Job Purpose : Under the direction of the Director of Primary Care, the Referral Specialist is responsible for managing and coordinating all patient referral needs.

This includes planning and arranging referrals to specialists, post-hospital care, home care services, and community agencies, as well as providing for special equipment when necessary.

The Referral Specialist ensures that patients are prepared for specialty service office visits by handling pre-certification, registration, and resolving case-related concerns prior to appointments.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.

• Coordinate and facilitate patient referrals to specialist by use of EHR (EPIC), ensuring all necessary paperwork, authorizations, and approvals are completed.
• Communicate with patients, healthcare providers, and insurance companies to verify coverage, obtain pre-certifications, and confirm that there are no financial barriers to receiving care.
• Collaborate with financial counselors, insurance carriers, and other healthcare staff to gather pertinent information needed for patient referrals.
• Resolve any registration and case-related concerns to ensure a smooth and efficient referral process.
• Maintain accurate and up-to-date records in the patient’s electronic health record (EHR) system, ensuring compliance with all relevant regulations and guidelines.
• Follow established protocols and guidelines to ensure that all referrals are processed in a timely manner.
• Attend seminars, training sessions, and meetings to keep abreast of the changing insurance policies and procedures, as needed.
• Print and fax appropriate medical records from Epic as needed.
• Comply with federal, state and local regulations regarding patient confidentiality and HIPAA.
• Support the primary care team by providing excellent customer service and patient-centered care.

Qualifications :

• High school diploma or GED is required; an associate’s degree or equivalent in a related field is preferred.
• 2-4 years of experience in a healthcare or medical office setting, particularly in referrals, case management, or a related area.
• Knowledge of commonly-used concepts, practices, and procedures in primary care and referral management.
• Strong understanding of insurance processes, pre-certification, and authorizations.
• Proficiency in using electronic health record (EHR) systems and other referral management software.
• Excellent communication and interpersonal skills to effectively collaborate with patients, healthcare providers, and insurance companies.
• Ability to work under immediate supervision and follow pre-established guidelines to perform job functions.

Outreach Community Health Centers welcomes all

Outreach Community Health Centers, Inc. is an Affirmative Action / Equal Opportunity Employer. We consider qualified applicants for employment without regard to race, religion, color, national origin, ancestry, age, sex, gender, gender identity, gender expression, sexual orientation, genetic information, medical condition, disability, marital status, or protected veteran status.

Company Description

Outreach Community Health Centers provides high-quality primary, family and behavioral health services to people throughout the Greater Milwaukee area.

Outreach Community Health Centers provides person-driven and evidence-based practices.

Outreach Community Health Centers maintains its founding mission to serve the homeless, those experiencing extreme poverty and the uninsured.

Outreach Community Health Centers serves the most disadvantaged people in Milwaukee County.

Our Mission is : To promote health and wellness to all individuals that we serve.

Company Description

Outreach Community Health Centers provides high-quality primary, family and behavioral health services to people throughout the Greater Milwaukee area.

Outreach Community Health Centers provides person-driven and evidence-based practices. r n r nOutreach Community Health Centers maintains its founding mission to serve the homeless, those experiencing extreme poverty and the uninsured.

Outreach Community Health Centers serves the most disadvantaged people in Milwaukee County. r n r nOur Mission is : To promote health and wellness to all individuals that we serve.