The Referral Scheduling Specialist processes orders and referrals to our providers and will observe and comply with medical insurance network guidelines and authorization requirements. In addition, they will be responsible for the following:
- Answer all incoming referral calls and process accordingly.
- Schedule incoming referral office appointments.
- Create and build patient charts in NextGen EPM system.
- Accurately enter required patient demographics (race, language, ethnicity, social security number, email address, referring provider etc.) into NextGen EPM system.
- Create referrals for Phreesia referral dashboard.
- Maintain and update referrals within the Phreesia referral dashboard.
- Initiate insurance verification process to confirm insurance eligibility.
- Process and review referral documents and add to patients chart.
- Obtain practice referral and / or pre-certification necessary for patients for internal and external referral appointments or orders.
- Communicate information pertaining to practice referral and / or pre-certification to patients, external medical offices and internal staff through Phreesia referral dashboard.
- Prioritize patient messages, referrals, and requests for prior authorizations according to their urgency.
- Develop and maintain data management systems, e.g., a tickler file, which enhances his/her capability to track patient referrals, authorization requests or messages effectively and efficiently, thereby ensuring the provision of comprehensive health care services to our patients.
- Maintain and routinely update patients' medical records with documentation related to referrals and phone messages that is pertinent, appropriate and concise.
- Educate and/or advise patients regarding care related issues, (within the scope of his/her training and job duties), in a safe, effective and appropriate manner.
- As requested, assist with the development or revision of protocols related to message and referral management.
- As requested, collect, aggregate and display data for Quality Assurance monitoring, Quality Improvement activities, reports, clinical plans, or other program efforts.
- Prepare reports and other documentation as required.
- Adhere to SSC Core Values:
- Trust
- Respect
- Integrity
- Clear Communication
- Collaboration
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