Records & Referral Specialist

At Promise Healthcare, our mission is to improve the health and well-being of the diverse communities we serve by providing high-quality, equitable healthcare to people of all ages. Our vision is to be a catalyst for positive change, shaping a future where healthcare is not a privilege but a fundamental right for every person and no one is left behind.

Be a part of a team that values excellence, equity, and community. If you're ready to lead with passion and precision, apply now to become our Records & Referral Specialist and help us make a lasting impact on the future of healthcare.

This position is responsible for tracking and executing referrals to outside providers and obtaining authorizations for services provided. This position also works with the clinical teams and is responsible for compiling, processing, and managing the information generated in the facilities.

ESSENTIAL DUTIES & RESPONSIBILITIES:

Referral related Responsibilities:

1. Schedules appointments and communicates information to the patient.
2. Follows preauthorization process.
3. Approve authorizations.
4. Deny pre-authorizations.
5. Checks insurance status on all pending referrals monthly for the following month using appropriate websites.
6. Completes the Referral Process.
7. Communicates quality of care issues to Supervisor and participates in the Plan-Do-Study-Act cycles to improve performance on targeted metrics.
8. Performs clerical duties.
9. Ensures attendance and hours worked are accurately recorded.
10. Properly manages earned time off per policy.
11. Responsible for regular and punctual attendance.
12. Assists the care team with patient No Show management.
13. Other duties as assigned.

Records related Responsibilities:

1. Perform specific functions in areas such as release of Protected Health Information requests.
2. Helps maintain patient files and records according to established PHC standards and federal and state laws.
3. Ensure that patient information is kept confidential and secure.
4. Responds to inbound/outbound documentation requests in a timely manner.
5. Follow established procedures for releasing medical records to authorized persons.
6. Retrieves electronic documentation from electronic health record upon request.
7. While working with the HIM supervisor, acts as a resource for related medical record requests and collaborates with providers to support patient care.
8. Helps HIM supervisor with clerical operations for the HIM department.
9. Helps HIM supervisor process subpoenas and court orders at the direction of the HIM supervisor.
10. Verify authorizations in accordance with PHC policy and procedures and state and federal laws.
11. Work with copy service to ensure all billable requests for copies of medical records are processed accurately in a timely manner.
12. Record/scan documents into the electronic health record.
13. Meet or take calls with patients as needed for ROI needs.
14. Helps manage Alcove, Medical Records, and School Base Fax boxes. Distributes incoming communication to designated staff.
15. Imports all incoming outside records and flags provider PAQ for review.
16. Help HIM supervisor manage Confirmed items in the EHR.

QUALIFICATIONS:

1. Must have the ability to communicate in a positive, customer service manner when communicating with all customers or when using telephone, email, etc.
2. Exhibits teamwork and excellent customer service skills without exception.
3. Requires basic organizational skills, typically to organize own work.
4. Job duties require the ability to work independently and as part of a team.
5. Job duties are typically performed in response to workflow or ongoing direction by supervisors or others.
6. Duties require the compilation of information.
7. Possess a basic level of written and verbal communication skills, computational and computer skills and mathematical knowledge.

EDUCATION / EXPERIENCE REQUIREMENTS:

1. Minimum one year experience in the medical field with knowledge of medical terminology and abbreviations and understanding of patient flow processes highly preferred.
2. Ability to appropriately communicate/deal with irritated or frustrated patients; to work under stressful conditions.
3. Knowledge of and ability to apply established professional customer service concepts, principles and practices.
4. Ability to prioritize and execute a variety of tasks simultaneously.
5. Ability to work with frequent interruptions.
6. Proficient computer skills.
7. Keen organizational skills.

AMAZING BENEFITS:

1. Medical
2. Dental
3. Vision
4. 401k with employer match
5. FSA
6. Vacation
7. Sick Leave

Proposed salary range: $32,000 to $39,000

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.

Completed background check and drug screen required prior to start date.