Referral Specialist - Waterville, United States - Northern Light Health

Northern Light Health Waterville, United States

1 week ago

Description

Northern Light Inland Hospital

Department:
Orthopedic Clinic

Position is located:
Inland Hospital

Work Type:
Full Time

Hours Per Week: 40.00

Work Schedule: 7:30 AM to 5:00 PM

Summary:

The primary function of the Referral Specialist is coordination, processing, and scheduling of medical referrals and prior authorizations for a variety of medical services as requested by primary care providers.

As an integral member of the health care team, the Referral Specialist manages a high volume of referrals and prior authorizations for multiple provider sin multiple locations.

Additionally, the Referral Specialist collaborates with other referral specialists, providers, clinical support staff, clerical support staff, and central scheduling in multiple locations.

The Referral Specialist Uses Northern Light Inland Hospital Standards of Behavior to always demonstrate professionalism with patients and coworkers. A team player is necessary for this position as well as variable skills. Fast paced setting requires independent thinking, ability, and willingness to be flexible and adaptable to change. There is opportunity to work from home once on-boarding is complete.

Responsibilities:

Manages and monitors all prior authorizations/outgoing referrals for the assigned departments/providers.
Utilizes EMR functions to document all pertinent information related to the referral.
Maintains appropriate workflows and processes for scheduling of referrals.
Organize and prioritize workload based on acuity.
Prepares, maintains, and distributes appropriate documents to referral source.
Effectively communicates with a variety of internal and external audiences in both oral and written form as appropriate. The audiences include, but are not limited to, clinical staff, providers, ancillary departments, insurance carriers, in-system, and out-of-system referral sites.
Works collaboratively with clinical staff, providers, ancillary departments, and insurance carriers to complete work.
Maintains referral tracking documentation to determine that referral is complete.
Maintains current knowledge of various insurance carrier processes necessary to obtain prior authorization and follows the prior authorization policy.
Maintains and safeguards confidentiality of information including patient, personnel, and organizational data/records.
Provides excellent service with focus on patient and/or customer experience and ensures all functions related to customer service supports the department, member organization, and patient related goals.
Attends and participates in meetings.
Attends educational sessions, workshops, and other continuing education opportunities to enhance or gain new skills.
Provides coverage for peers on an as needed basis.
Must be able to perform all essential duties related to the PSR role. The incumbent must be competent to fulfill the PSR role when or as needed. Those duties and tasks may include, but are not limited to monitoring patient schedule, scheduling, rescheduling, and following up on missed appointments, answer telephone calls, document messages appropriately, register patients or other duties as assigned.
Maintains safety standards and reports safety issues immediately.

Other Information:
Competencies and Skills

Achieves Results:

Sets high standards for their own outcomes and seizes opportunities to engage others towards objectives. Consistently moves forward with direct actions in order to attain or exceed objectives. Manages their own time effectively to accomplish assigned tasks. Successfully prioritizes multiple projects and duties as needed.

Behaves with Integrity and

Builds Trust:
Acts consistently in line with the core values, commitments and rules of conduct. Leads by example and tells the truth. Does what they say they will, when and how they say they will, or communicates an alternate plan.

Cultivates Respect:

Treats others fairly, embraces and values differences, and contributes to a culture of diversity, inclusion, empowerment and cooperation.

Demonstrates Adaptability:

Learns quickly when facing a new problem or unfamiliar task; is flexible in their approach with changing priorities and ambiguity.

Manages change effectively and does not give up during adversity. Capable of changing one's behavioral style and/or views in order to attain a goal. Absorbs new information readily and puts it into practice effectively.

Demonstrates Emotional Intelligence:

Exhibits a high level of self-awareness, self-management, other awareness and relationship management. Conducts themselves in an empathic, appropriate way, with a sense of humor and stimulates a collaborative work environment.

Is respectful of the attitudes, feelings, or circumstances of others and aware of the influence of their own behavior on them.

Is aware of relevant social, political, system, and professional trends and developments and uses this information for the organization's benefit.

Develops Self and Others:

Takes responsibility for engaging in professional self-development activities and programs.

Strives to gain insight into their own values, strengths and weaknesses, interests and ambitions and takes action in order to enhance competencies and skills when possible.

As a leader, encourages and guides employees towards growth opportunities to enhance performance and help them reach goals.

Reviews and analyzes employees' strengths and weaknesses to distinguish their talents and development needs, and to ensure they are enhanced appropriately.

Effectively Communicates:

Listens, speaks and writes appropriately, using clear language. Communication methods are fitting to the message(s), audience, and situation and follow-ups are regular and timely. Shows that important (non-) verbal information is absorbed and understood and asks further questions to clarify when necessary. Expresses ideas and views clearly to others and has ability to adjust use of language to the audiences' level.

Exercises Sound Judgment &

Decision Making:
Understands and processes complex information, which allows for appropriate and accountable conclusions. Does not react too quickly or slowly. Balances facts, goals, and potential approaches taking the appropriate criteria into account. Makes active decisions and commits oneself by communicating confidently and respectfully.

Fosters Accountability:

Creates and participates in a work environment where people hold themselves and others accountable for processes, results and behaviors.

Takes appropriate ownership not only of successes but also mistakes and works to correct them in a timely manner. Demonstrates understanding that we all work as a team and the quality and timeliness of work impacts everyone involved.

Fosters Innovation:

Employs and encourages the use of meaningful creativity in solving challenges. Proactively identifies opportunities and uses new approaches to enhance processes, systems and services. When appropriate, suggests or initiates new strategies, products, services, and markets.

Influences and Inspires:

Builds enthusiasm and commitment among others to move in a desired direction and models it personally. Creates a compelling vision of success that motivates workplace initiative and energizes others to follow. Provides direction and guidance to encourage cooperation between team members in order to attain an objective. Has the ability to appropriately influence others' actions and decisions with and without express authority.

Practices Compassion:

Exhibits genuine care for people and is available and ready to help; displays a deep awareness of and strong willingness to relieve the suffering of others.

Promotes Health and Safety:

Promotes a healthy and safe environment for patients, employees and visitors. Advocates and models healthy physical and mental health behaviors even in challenging circumstances.

Sets high quality standards and strives for continuous improvement and quality assurance by reporting and encouraging others to report near misses and safety issues.

Provides Patient-Centered Care:

Demonstrates understanding of patient care quality and service as organizational priority. Proactively supports change to improve patient experience and results.

Exhibits the ability and willingness to find out what the patient wants and needs and to act accordingly, taking the organizational and outside resources into account.

Cooperates, collaborates, communicates, and integrates care within and between teams to ensure that care is continuous and reliable.

Serves Others:

Strives to understand, meet and exceed the expectations and requirements of internal and external customers which may include the people and communities in our service areas.

Develops and maintains relationships, alliances and coalitions within and outside the organization and leverages them in order to obtain information, support, and promote cooperation and collaboration.

Utilizes Resources Effectively:

Understands how to get the most out of available resources and uses cost-benefit thinking in decision-making and in setting priorities.

Monitors and analyzes resource usage to identify and eliminate areas of waste and maximize resources. As a leader, defines targets and provides appropriate means; oversees progress and makes adjustments when necessary. Appropriately delegates work, sets clear direction and manages workflow and time.

Education

Required High School Diploma/General Educational Development (GED)

Working Conditions

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