Care Referral Specialist

Responsibilities

Responsible for ensuring that the referral management process is complete and accurate at the FSU PrimaryHealth™ clinic. Refers patients to specialist according to insurance guidelines, obtains authorizations for new and follow up visits and ancillary appointments. Handles call-in requests for authorizations.

Posts all referrals made on a daily basis into clinic referral log. Documents any referral denials in electronic medical record system. Communicates all rejected referrals with providers and follows through with any adjustments made. Answers inquiries about referrals following policy turnaround guidelines. Advises providers when diagnosis will not cover requested ancillary service. Educates providers and other office staff on changes to ancillary scheduling changes, authorization guidelines, and specific referral problems.

Contact patients with appointment times and instructions, or if referral cannot be scheduled. Gives patient information on medication or prep needed for tests of ordered referral.

Attends appropriate managed care payors sessions to ensure appropriate referral processing. Access, use and disclosure of Protected Health Information (PHI) are limited to a Professional Need to Know in accordance with FSU College of Medicine HIPAA policies and procedures. Contributes to the efficient operation of the clinic by performing other related duties as may be required. Promotes an atmosphere of teamwork in accomplishing the mission and goals of FSU PrimaryHealth™. Exhibit a willingness to float to all areas of need for administrative support including check-in, check-out, referrals, or other administrative areas as deemed necessary. Maintain confidentiality of all personal health information. Assure that information is maintained, handled, and released in accordance with applicable federal and state statutes and FSU PrimaryHealth™ policies.

Qualifications

High school diploma or equivalent and four years of experience. (Note: post high-school education and/or experience may substitute at a comparable rate.)

Post-job offer, but prior to hire, the following will be required:

• Documentation of current PPD (Purified Protein Derivative) test as performed by a qualified physician, reporting negative results within the past six (6) months.
• Documentation of physical examination completed by a qualified healthcare provider/physician within the past six (6) months.

Within 30 days of hire, the candidate must provide:

• Documentation of Tetanus immunization within 10 years.
• Documentation of Hepatitis B vaccine or positive antibody titer.