On the outside, Trillium Health may look like a neighborhood health center that provides accessible, affordable services to the community. On the inside, we’re focused on caring for all of an individual’s needs. “Extraordinary care, always,” is not just our noble purpose at Trillium Health, it’s our operational system. Our mission targets the complex vulnerabilities of our community, as we address the social, physical, and behavioral needs of those we serve, all under one roof.
Born from the HIV/AIDS epidemic, Trillium Health has grown into a Federally Qualified Health Center (FQHC) Look A-Like, allowing us to expand our reach and serve those who too often face barriers to care. From primary medical care, to LGBTQ affirming care, we are committed to our community. If you are interested in an organization that truly cares, Trillium Health may be for you.
We are currently recruiting for a Referral Specialist. This position is part time 23 hours per week.
The Referral Specialist is responsible for serving as a primary interface between patients and clients, doctor offices, medical facilities and community agencies. S/he will coordinate all referrals from Trillium providers and care management and ensure that patients/clients are scheduled for their services. The position will also track whether the clients followed up to obtain their services for which they were referred.
Assign the patient to the appropriate specialty provider or facility based on the patient’s current medical needs as defined by the primary care provider.
Provide all the required medical history information regarding the patient to the specialty provider or facility.
Determine primary responsibilities for the medical bill and identifying any changes made by the clients or payers.
Coordinate with insurance carriers and specialty practices to obtain prior authorizations, pre certifications and referrals on applicable plans which include HMO, PPO and POS health plans and documents all benefit information into the patients’ electronic medical record.
Coordinate and communicate with Care Managers and other departments to facilitate the financial counseling and other insurance issues.
Ensure that patient’s financial counselor is aware of any copayments, deductibles, etc.
Fax medical documentation as needed and requested by clinical staff and outside agencies.
Keep both the patient/client and the corresponding provider informed of scheduled details such as day/time and place of visit.
Assist in providing information to the patient/client on any preparation required before the visit.
Inform the specialty provider or facility of any special needs for the patient such as interpreters, transportation, escort, etc.
Enter all the referral information into the electronic medical record system.
Contact patient, specialty provider or facility to reschedule missed appointments for patients if applicable.
Schedule any pre and post follow up appointments with the medical or specialty provider if applicable.
Obtain all labs, radiological, surgical and other medical reports from the specialty provider or facility to ensure continuity of care.
Send all pertinent information to the referred organization.
Referral Tracking and Quality Reporting
Keep track of patient/client referrals in the system and follows up with clients who have missed referral appointments.
Maintain an accurate up-to-date monthly report of scheduled patient offsite appointments.
Run and monitor a weekly crystal report to capture any missed referrals made by the providers.
Track and maintain a “No Show” report for offsite appointments and informs the providers, care managers and other staff if applicable.
Maintain any quality reports required to meet Patient Centered Medical Homes, Meaningful Use and Health Homes requirements.
Follow up with facilities for patient/client information.
Requires the ability and commitment to respect and support inclusiveness and diversity including but not limited to individuals of different backgrounds, cultures, races, ages, sexual orientations, gender identities or expressions, experiences, opinions, etc.
Requires individual demonstration of commitment to the One Trillium behaviors and business impacts and modeling them in the organization.
Responsible for maintaining confidentiality of all patient, client, employee, protected and proprietary information.
Employees are accountable for meeting the performance standards of their departments and must participate as requested in compliance audits, process improvement and quality improvement plans.
Other specific duties as assigned.
High School diploma or GED required with a minimum of 2 years recent insurance verification, referrals and prior authorization experience in a medical office or clinic is required. Associate’s degree preferred in Health Education, Health and Human Services.
Excellent verbal and written communication skills, good typing and computer skills. Excellent customer service skills, team player and positive attitude. Ability to make decisions and solve problems. The ability to speak, read or write a foreign language is desirable.
While performing the duties of this job the employee is required to stand and walk; use hands to reach, finger, handle and feel; reach with hands and arms; talk and hear on a regular basis. Occasionally the employee must stoop, bend and climb stairs is requires. The employee must be able to lift and/or move up to 25 lbs. Specific vision abilities required include close vision, distance vision, peripheral vision, depth perception and ability to adjust focus.
In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.