Patient Access Referral Specialist I

Regional One Health; Memphis (TN); On-site; USD 35,000 - 48,000; Full time

Job summary

Regional One Health in Memphis is seeking an Outpatient Patient Access Referral Specialist to coordinate all patient referrals to specialty and diagnostic services.

You will obtain necessary patient information, secure pre-certifications, ensure ICD/CPT coding accuracy, schedule appointments, arrange transportation, and document communications in the referrals system.

Qualifications

• High School diploma or equivalent is required.
• At least 1 year of clerical experience is required.
• Experience in authorizing referrals is preferred.

Responsibilities

• Coordinate patient referrals to appropriate specialties or diagnostic services.
• Obtain pre-certification/authorization from MCOs/insurance.
• Ensure proper ICD/CPT coding on Referral Form.

Skills

Clerical experience

Referral authorization

Education

High School Diploma or equivalent

Job description

JOB SUMMARYThe Outpatient Patient Access Referral Specialist coordinates all patient referrals made by Providers to appropriate specialties or for diagnostic services. Obtains and documents in patient records, receipt of certification and authorization from Third Party reimbursement companies (MCOs, HMOs, PPOs). Ensures providers have test results available in a timely manner. Completes follow-up referrals.Key Job ResponsibilitiesEssential FunctionCollaborates with providers regarding patient diagnosis and need for referral.Obtains all relevant patient information needed to make referral and obtains pre certification and/or authorization from appropriate MCOs/insurance agency.Ensures proper ICD or CPT coding is completed on Referral Form. Ensures completeness of referral documentation form by provider.Investigates appointment schedules and coordinates with patients regarding their availability and scheduling needs and in accordance with available appointment openings at specialties. Ensures appointment schedules are coordinated within established guidelines set by contracting agencies. Patient Appointment Reminder System.Arranges for patient transportation prior to appointment.Contacts Third Party Reimbursement/Certification Departments to obtain authorization for referral. Documents all communication on Referral/Certification Form and enters data into computerized referrals program.Ensures completeness of all patient data/demographic information. Forwards necessary documentation to referring physician/diagnostic service.Ensures that reports from consulting physicians, discharge summaries, diagnostic reports, etc. are received, reviewed and signed within two (2) weeks following appointment and filed appropriately.Pending reports/results are followed up with referring agency and/or patient as appropriate. No show or rescheduled appointments are reported to the provider and documented in the patient’s chart on the referral form, along with the date of entry and the initials of the referral clerk.Collaborates with the Community Outreach Coordinator regarding patient care follow-up and satisfaction level as it relates to referral.Physical DemandsA thorough completion of this section is needed for compliance with legal standards such as the Americans with Disabilities Act. The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.Physical DemandN/ARarelyOccasionallyFrequentlyConstantlyWeightStandingXWalkingXSittingXLiftingXCarryingXPhysical DemandsA thorough completion of this section is needed for compliance with legal standards such as the Americans with Disabilities Act. The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.Physical DemandN/ARarelyOccasionallyFrequentlyConstantlyWeightPushingXPullingXClimbingXBalancingXStoopingXKneelingXCrouchingXCrawlingXReachingXHandlingXGraspingXFeelingXTalkingXHearingXRepetitive MotionsXEye/Hand/Foot CoordinationXEducationEducation LevelEducation DetailsRequired/ PreferredHigh SchoolGraduate or equivalent with related course work.RequiredWork ExperienceExperienceExperience DetailsRequired/ PreferredAt least 1 year experienceTwelve (12) months clerical or completion of a clerical training programRequiredandExperience in authorizing referralsPreferred