Central Referral Representative

DEPARTMENT: Central Referral department

REPORTS TO: Central Referral Supervisor

 

Summary:

The Central Referral Representative is responsible for coordinating outpatient testing and specialist referrals, which are generated by clinic Providers in the United Health Center system. Answer incoming telephone calls from patients and physician offices, and calling to inquire about existing referral appointments. The Central Referral Representative works with patients, insurance carriers, and physician offices in a professional and courteous manner. The Referral Representative is responsible for maintaining a well-organized work station and documenting benefits, appointments and orders in I2I tracks, an electronic data base.

Summary of Responsibilities:

* Coordinates referrals to specialty providers.

* Coordinates orders for outpatient testing.

* Schedules appointment, advises patient, prepares referral packets and mails it to patients’ home.

* Completes and faxes order form.

* Coordinates follow-up.

* Maintains up-to-date documentation in I2I.

* Addresses questions from patients via telephone and in person related to specialty appointments and procedures.

* Answer incoming calls on a multi-line phone system.

* Copying/scanning.

* Promptly and courteously answers and screens phone calls for the department; routes call as appropriate within established customer service guidelines; accurately records messages and delivers to the appropriate party in a timely manner; checks voicemail frequently.

* Provides outstanding customer service to internal and external customers.

* Reports any potential customer concerns or complaints immediately to management.

* Utilizes protocol for patient look up to ensure accurate identification of patient to ensure data integrity and patient safety.

* Daily, print, plan and review of I2I report.

* Reporting any potential time constraints or bottle necks that could prevent you from completing referral to designated provider and / or care team.

PERFORMANCE AREA 1:

a. Representative will accept task and create referral packet

b. Representative will complete authorization process with patient insurance

c. Representative will document all referral activity in I2I

d. Representative will be responsible for patient notification of all referral activity and status changes

PERFORMANCE AREA 2:

a. Representative will be responsible for receiving and inputting all referral information

b. Representative will be responsible for synchronizing data into providers PAQ

c. Representative will be responsible for synchronizing data into ICS

d. Representative will be responsible for all on going communication within referral process

e. Supports UHC customer service expectations by providing benefit and contact information to patients and staff when issues/concerns arise

f. Supports team development by keeping current on internal and payer changes as they occur and communicates changes within the group

General Corporate Expectations:

a. Attends and actively participates in all meetings (e.g., department meetings, program meetings, employee staff meetings) and other activities as required or assigned.

b. Attend/complete trainings and certification as required by Covered California.

c. Attends workshops/seminars as necessary to increase skills and knowledge to provide effective care, treatment, and/or leadership.

d. Supports the overall needs of the department by working flexible or extended hours when necessary.

e. Displays a positive, professional and respectful demeanor at all times toward employees, peers, professional contacts, and patients served, maintaining a professional appearance and positive image for the department.

f. Contributes to the team by promoting positive staff interaction, maintains open communication with other programs/departments.

g. Demonstrates awareness of, and compliance with, organizational mission and objective of UHC to provide health care access and support services for all members of the community.

h. Supports their own staff development by completing the required hours of continuing education each year.

i. Other work-related duties as assigned by supervisor. Duties and responsibilities may be added, deleted, or changed at any time at the discretion of management, formally or informally either verbally or in writing.

j. Maintains confidentiality and respect for information regarding patients and other team members; abides by UHC Rules of Confidentiality and general HIPAA regulations regarding privacy.

QUALIFICATION REQUIREMENTS:

EDUCATION AND LICENSE/CERTIFICATION:

* High School Graduate.Associates Degree preferred.

PRIOR EXPERIENCE:

* Minimum 2 years of experience in a health center setting

* Knowledge in scheduling

* Knowledge of referral processing

SKILLS

* Bilingual (English/Spanish) required

* Able to quickly build and maintain rapport with patients and providers of differing backgrounds

* Team player

* Customer-service expertise.

* Strong computer skills

* Positive professional insight

* Flexibility and dependability

* Demonstrated good problem-solving skills; sound judgment

* Good writing skills.

* Modern office practices and procedures including email

* Attention to detail and excellent follow-through on work tasks

* Able to handle multiple tasks simultaneously

PHYSICAL REQUIREMENTS

* Must be able to lift up to 20 pounds and push up to 50 pounds (on wheels).

* Must be able to hear staff on the phone and speak clearly in order to communicate information to patients and staff.

* Must be able to read memos, computer screens, personnel forms and clinical and administrative documents.

* Must have high manual dexterity.

* Must be able to reach above the shoulder level to work, must be able to bend, squat, sit, stand, stoop, crouch, reach, kneel, and twist/turn

Additional job information:

Hours of Operation: Must be available to work non-standard hours and overtime based on work volume. Hours of operation are 8:00 AM to 8:00 PM, schedules may vary. Successful applicants must be flexible with their start and end times, as work hours will be based on the business needs of our internal and external customers. Applicants will be required to rotate and work a variety of shifts, which may include weekends.

Travel: may be required to travel to other health centers and community events.