Referral Specialist

Community Action Partne; Gering (NE); On-site; USD 42,000 - 56,000; Full time

Benefits offered by this job

Competitive benefits package

Full-time (40 hours)

Job summary

Community Action Partnerships of Western Nebraska (CAPWN) seeks a Referral Specialist to support clinic patients by coordinating external and internal referrals, documenting progress in EMR, and assisting scheduling and preauthorizations.

This full-time role engages with clinical staff within a patient-centered medical home framework; it requires HIPAA knowledge, strong communication, and organizational skills. Typical hours are 8:00 AM to 5:00 PM, Monday through Friday.

Qualifications

• Strong communication and interpersonal skills for frontline referrals.
• Knowledge of HIPAA privacy and security requirements.
• Experience with Microsoft Office suite and EMR documentation.
• Ability to organize, prioritize, and manage competing tasks.
• Familiarity with referral tracking policies and patient care workflows.

Responsibilities

• Coordinate external and internal referrals for clinic patients and ensure timely processing.
• Document referral progress in EMR and notify providers as needed.
• Schedule, follow up, and complete referrals with appropriate preauthorizations.
• Maintain patient safety and compliance with Patient-Centered Medical Home guidelines.
• Assist training of ordering providers and support staff on referral workflows.
• Protect patient confidentiality per CAPWN policies.

Skills

Communication skills

HIPAA knowledge

Microsoft Office

Adobe programs

Organizational skills

Grammar and editing

Tools

EMR system

Microsoft Office

Adobe programs

Job description

Community Action Partnerships of Western Nebraska (CAPWN) is a non-profit community-based health and human services organization that serves low-income, disadvantaged and those unable to meet their needs through other sources. The agency was established in 1965 and provides services to over 9,000 individuals, children and families in three main areas:

• Community Health Services: WIC, Commodity Supplemental Food, Foster Grandparents, Head Start, and Child Development Center.
• Clinical Health Services: Primary Care, Reproductive Health, Diabetes Management, Immunizations, Migrant Health, Ryan White HIV; Behavioral Health including Counseling Services, Medication Management, Medication Assisted Treatment and Substance Use Counseling and Intensive Outpatient Services and Dental Services.
• Supportive Health Services: Family Stabilization, a Teen Outreach Program, SOAR, Youth Leadership Program, Youth Shelter and Housing Assistance Programs.

OUR PROMISE: Community Action changes people’s lives, embodies the spirit of hope, improves communities, and makes America a better place to live. We care about the entire community, and we are dedicated to helping people help themselves and each other.

VISION

Communities where everyone has an opportunity for a successful life.

MISSION

The Mission Statement of the Community Action Partnership of Western Nebraska is to provide quality services and promote learning opportunities to improve nurture the health and well-being of Western Nebraska communities.

KEY BELIEFS

• Integrity— We treat all people with dignity and respect.
• Compassion— We believe working compassionately with people enriches all.
• Inclusion— We are inclusive and advocate for diversity.
• Collaboration— We believe working in partnerships strengthens communities; we seek mutually beneficial partnerships that advance a common mission.
• Innovation— We embrace opportunities to learn, grow and make wise choices.

COMPETITIVE BENEFITS PACKAGE:

Fulltime (40 hours)

8:00 AM to 5:00 PM

Monday to Friday

Job Title: Referral Specialist

Reports To: Primary Care Nurse Supervisor

Areas of Responsibility:

Ensure the effective management of all external and internal referrals. Schedule, follow-up, and complete referrals for clinic patients. Appropriately document referral progress in the Electronic Medical Record (EMR). Work with clinical staff to ensure appropriate scheduling, notifying the ordering provider when referral appointments are not kept, and preauthorization’s as required. Follow Patient-Centered Medical Home and Federal Tort Claim Act requirements to ensure patient safety.

Major Duties

• Play an active role in patient care using the provider led, Team-Based, Patient-Centered Medical Home Care Model.
• Assemble information concerning patient’s clinical history and referral needs. Per referral guidelines, provide appropriate clinical information to specialists and exchange information with outside entities to verify prior authorizations for procedures.
• Ensure referrals are addressed in a timely manner including sending referrals, scheduling, follow-up, and requesting and receiving records, completing referrals in the patient’s EMR.
• Maintain ongoing tracking and appropriate documentation on referrals to ensure patient safety.
• Complete Preauthorization of procedures with insurance companies.
• Follow-up with the patient or external agencies per CAPWN Referral Tracking policy and procedures.
• Review details and expectations about the referral with patients, including financialassistance programs that are available at the referralsite.
• Assist in training ordering providers and support staff.
• Become knowledgeable of community and CAPWNresources.
• Identify and utilize cultural and community resources. Establish and maintain relationships with identified serviceproviders.
• Ensure that a patient’s primary care chart is up to date with information on specialistconsultations, hospitalizations, ER visits and community organization related to theirhealth.
• Attend staff training sessions and meetings asrequired.
• Maintain confidentiality of records and communications following CAPWN policy and HIPAA privacy and security policies and procedures.
• Maintain a positive and professional attitude, striving to openly communicate with co-workers and patients, breaking down communication barriers whennecessary.
• As a CAPWN team member, dedicate your energy to providing high quality, value-added customer service and care to our clients. Embrace the CAPWN Standards of Behavior, practicing integrity, strong communication and respect for leaders and peers. Engage with the team and commit to improving and nurturing the health and well-being of the Western Nebraska Communities we serve.
• Perform other duties as assigned.

Work Conditions

• 90% office work, 10% training andmeetings.
• Well-lit, temperature controlled clinical setting, with standard medical and office equipment available.
• Work can be stressful and requires ability to meet tight timelines and flexibility of changes in dailyroutine.
• Able to concentrate within the everyday distractions of a medical office/business.
• Able to work independently, analyzing and assessing workflow and turnaround times while following established policies and procedures with minimalsupervision.
• Able to understand technology of clinicalsoftware.
• The noise level in the work environment is usuallyaverage.

Physical Requirements

• Ability to bend, stoop, walk, lift and sit.
• Ability to sit and /or stand for long periods oftime.
• Occasionally lifting and carrying up to 25pounds.
• The position requires sedentary work, with use of headphone, keyboard and video display terminal.
• Must regularly talk, hear and have close vision ability to record and communicate appropriate documents andrecords.

Minimum Qualifications

Grade:1

2. Ability to work alone and unsupervised

3. Two years of experience in a health care clinic, referral processing preferred

4. Have a working knowledge of HIPAA Privacy Regulations, maintaining confidentiality in the provision of all services including written and/or oral reports

5. Requires proficient level of oral and written communications with proven skills in grammar, punctuation, style, and editing

6. Have a working knowledge of Microsoft Office and Adobe programs

7. Organized and able to manage competing priorities

5. Successful completion of Medical Terminology course or equivalent, preferred

Grade: 2

1. Must meet minimum qualifications above with;

2. Completion of coding course or equivalent

3. Three years of experience in health care setting

Grade: 3

1. Must meet minimum qualifications above with;

2. Associate’s Degree OR

3. Five years of experience in a healthcare clinic setting

"We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, parental status, national origin, age, disability, genetic information, political affiliation, military service, protected veteran status, or any other characteristic protected by law.