Steward Health Care Network
Steward Health Care Network
This position will be a key member our referral management department and be responsible for specialty referral management, referral coordination, and patient scheduling in support of the Steward Health Care Network physicians, hospitals and their patients. The primary role of the Referral Management Specialist is to support PCPs and their practices in their effort to manage patient specialty referrals, and to facilitate patient scheduling within the SHCN network. This position will have an expertise in the breadth of specialty services provided both within the chapter structure, and regionally across the SHCN network, and will assist PCP practices and their patients with understanding their referral options. This position will contribute to the refinement of the SHCN provider database, and will communicate frequently with patients, provider referral staff, and SHCN and chapter leadership. This position will also contribute to the business line need awareness within the SHCN network.
1. Ensure accurate and timely responses to all referral requests and inquiries regarding SHCN specialty services.
o Receives incoming referral requests from primary care physician practices.
o Verifies eligibility and reviews patient demographics.
o Researches, investigates and develops an understanding and expertise regarding the ability of the SHCN chapter and provider network to meet the needs of patients requesting specialty referrals.
o Engages patients by telephone to discuss referral requests and appointment needs when necessary.
o Coordinates referral requests with PCPs and their practices, specialty practices, and with other clinical consultants as appropriate.
o Schedules patient appointments by contacting physician practices or scheduling directly in an electronic medical record when appropriate.
o Communicates with physician practices and patients as needed regarding referral management expectations and best practices.
o Educates PCP practices and their patients on referral request expectations and guidelines.
o Confirms appointments and/or referrals with physician practices and patients.
o Researches and inventories the breadth of specialty services provided both within the local chapter and regionally across the SHCN network.
o Supports the development of the SHCN provider database and the DoctorFinder website.
o Communicates and collaborates with Chapter Performance Directors, hospital medical staff and marketing personnel as necessary.
o Assures that all necessary documentation and data collection occurs in a timely manner within SHCN systems.
o Contributes to critical data capture, reporting and understanding.
o Reviews data and performance reports.
o Assists in the audit of PCP practice referral management processes and supports the development of effective referral management services within PCP practices.
o Achieves established performance targets.
o Meets established quality expectations e.g. confidentiality, accuracy, customer service and professionalism.
o Supports other departmental team members to assure turnaround time expectations are met.
o Attends and regularly participates in team and/or departmental meetings.
o Communicates important information to team members.
o Contributes to team efforts to improve workflow and efficiency.
3. Provide Outstanding Customer Service
o Goes the 'extra mile' to assure that customer expectations are met.
o Provides a high level of satisfaction to both internal and external customers.
o Effectively listens and provides customers with undivided attention.
o Anticipates customer needs, and devotes time and attention to customers so they feel important and appreciated.
o Helps customers understand processes and procedures.
o Knows how to apologize when something does not goes as intended and provides superior follow up response.
4. Assists with other projects within the department on an "as needed" basis.
5. Demonstrates respect and regard for the dignity of all patients, families, visitors, and fellow employees to ensure a professional, responsible, and courteous environment.
o Commits to recognize and respect cultural diversity for all customers (internal and external).
o Communicates effectively with internal and external customers with respect of differences in
o cultures, values, beliefs and ages, utilizing interpreters as needed.
6. Performs other duties as assigned.
REQUIRED KNOWLEDGE & SKILLS:
a) Knowledge of insurance, medical office practice and/or referral processing.
b) Demonstrated ability to respond to insurance referral requests and/or physician appointment requests in a timely manner.
c) Excellent organizational skills and attention to detail.
d) Ability to provide superior customer service.
e) Demonstrated understanding of the need for patient confidentiality in a HIPAA compliant environment.
f) Self motivated
g) Comfortable engaging patients and speaking with physician office personnel.
h) Demonstrated ability to work independently and as part of a team.
j) Strong verbal and written communication skills.
k) Requisite poise, judgment and skills to represent Steward Health Care Network to internal and external customers.
I. Education: High school diploma. Associates degree preferred.
II. Experience (Type & Length): At least 3-5 years experience in healthcare related field. Medical office experience required. Referral management experience preferred. Experience with communicating with patients is strongly preferred.
III. Certification/Licensure: N/A
IV. Software/Hardware: MS Office, Excel, Athena, Meditech, Emdeon, Medical Scheduling Software
V. Other: Fluency in a foreign language is desirable e.g. Russian, Portuguese, Haitian Creole and Vietnamese.
Job Reference #: 45680