Referral Associate

Job Requirements:

Job Summary

• Exempt: No
• The referral associate is a well-organized individual with excellent communication skills to promote the care continuum to referral sources and the community at large resulting in efficient patient care flow. This position requires an in-depth understanding of services offered both through the Adventist Health continuum of care as well as out-sourced referrals in the greater medical community. The referral associate is the primary contact between the patient and the medical community to which they are referred. This individual works under general supervision of the nursing coordinator, physicians and RN, in a controlled patient care area and performs a variety of duties. This position is represented by RCHEA. 

Standards of Behavior

Line of Responsibility and Authority

• LINE OF AUTHORITY: Referral Associate (Outpatient) - Clinical Manager/Practice Administrator

Professionalism and Self-Development

Education and Qualifications

• EDUCATION AND EXPERIENCE: Clinic/medical office experience preferred
• EDUCATION AND EXPERIENCE: High School graduate or GED preferred
• QUALIFICATIONS: Excellent working knowledge of excel, word processing software, POMS and email calendars

Physical Requirements/Work Environment/Use of Senses and Communications Skills

• ACCOMMODATIONS: The physical demands and work environment characteristics described here are representative of those an employee typically encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the key responsibilities and essential functions
• CONFIDENTIALITY: Employee must conform with all HIPAA and other confidentiality regulations as required by the job, department, or hospital
• EQUIPMENT USED: Cell phone
• EQUIPMENT USED: General office equipment, including computer, printer, calculator, copy machine and other office equipment
• PHYSICAL REQUIREMENTS (A): This job requires frequent bending, squatting, kneeling, climbing, reaching above shoulders, sitting, walking inclines and declines, standing, talking, hearing, and performing repetitive hand motions. Vision requirements include close vision and the ability to adjust focus. The employee will occasionally lift boxes and/or supplies weighing up to 25 pounds. The employee must demonstrate lifting a 25-pound box from the floor.
• POTENTIAL EXPOSURE TO BLOOD & BODY FLUIDS: Category 3 for potential exposure to blood/body fluids. (Does not require the performance of procedures or other tasks in the work routine that involve exposure to blood, body fluids or tissues, and the assisting in the cases of emergency medical care or first aid is not a requirement or employment. Tasks that involve handling of implements or utensils, use of the public or shared bathroom facilities, telephones, and personal contacts such as handshaking, are all considered Category 3 tasks.)

Job Roles

Referral Associate (Outpatient) (AHCL)

• Acts as back office information center for fax, phone, mail, diagnostic reports and all aspects of ongoing clinical care. Completes data collection, input, reporting and general program support.
• Assists in the coordination of patient care in the area of medical records procurement
• Ensures patients have achieved specialty service referral. Resolves pre-certification and case-related concerns prior to the referral appointment.
• Gathers pertinent information from insurance carriers, financial counselors and other ancillary staff to make certain the referral can be taken to completion.
• Identifies in-house, local and regional medical and social resources.
• Maintains a records program for documentation of the referral process.
• Maintains and meets expectations on time for all competencies, certifications and education requirements as outlined by local administration, Adventist Health (AH), The Joint Commission (TJC), Centers for Medicate and Medicaid Services (CMS), and all other regulatory agencies.
• Performs diagnostic coding relative to the referral process, ICD-9 and CPT-Plus
• Processes completely all inside and outside referrals.
• Willingly performs other duties and innovations as assigned.