Referrals Specialist

Job Code: 29-2072 Status: Full-time, Permanent

Salary: $31,241.60 - $65,894.40 Location: Health Services

Department: Business Office Reports to: Health Information & Referrals Supervisor

SUMMARY: Under the direction of the Health Information & Referral Supervisor, the Referrals Specialist will compile, process and maintain referrals for health care services in a manner consistent with medical, administrative, ethical legal and regulatory requirements in all areas of the Business Office. Referral specialist will work as part of the Business Office team in planning, coordination and management of the health care delivery system.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following:

• Timely review and processing of referrals entered by primary care providers for referred health care services using the Resource Patient Management System (RPMS) referred care information system (RCIS) application according to the business office policy and procedures.
• Follow up and resolve outstanding tests, orders and referrals to ensure timely and accurate scheduling, processing and availability of results for providers.
• Complete all work functions timely and efficiently.
• Maintain organization in the overall management of outstanding tasks.
• Follow up with provider(s) on outstanding documents which prevent processing of tests/orders/referrals.
• Verify patient eligibility for services, scope of services, medical priority, and alternate resources according to the Purchased/Referred care (PRC) policies and procedures and submit referrals to administration for approval.
• Request all necessary medical information from health information management staff to be sent to outside provider for scheduling of appointments.
• Notify patients the date and time for appointments from outside providers and relay any outside provider specific instructions.
• Enter referrals for all call-in notifications and emergency department/urgent care visits on the log for health administration review/approval where applicable.
• Maintain up-to-date record keeping of notes in RCIS for all referrals.
• Notify uninsured patient and pend all designated medical priority referrals until patient complies with alternate resource policy.
• Request alternate resource letter be sent to uninsured patient from patient registration staff.
• Process prior medical authorizations from third party insurances required for an appointment from Medicare, Medicaid, and/or private insurances where applicable.
• Communicate and report complaints, problems, and concerns to Health Information & Referrals Supervisor when needed.
• Deal with patients sensitively and professionally at all times.
• Scans all orders into patient electronic health record(s).
• Trains new/inexperienced staff in referrals processes.
• Assists in the development and modifications of business office policies and procedures.
• Attends meetings/trainings as requested by Health Information & Referrals Supervisor/Business Office Manager.
• Assures HIPAA compliance with regard to referral practices.
• Other related duties as assigned (including patient registration, health information management, purchased/referred care, accounts payable, third party billing and accounts receivable).

SUPERVISORY RESPONSIBILITIES: There are no supervisor requirements for this position.

QUALIFICATION REQUIREMENTS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Due to the sensitive nature of information and personnel files maintained within Human Resources, must maintain strict confidentiality at all times.

EDUCATION and/or EXPERIENCE: High School Diploma/GED and one year medical office or billing experience, certificate in office administration or related preferred.

OTHER SKILLS and ABILITIES: Strong oral and written communication skills required. Must have excellent computer skills including word and excel.

REASONING ABILITY: Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

The Saint Regis Mohawk Tribe strives to be an equal opportunity employer dedicated to the policy of nondiscrimination based on race, sex, marital status, sexual orientation, religion, national origin, age, physical disability, veteran status or any other non-job related factor.

The successful candidate must pass a test for illegal substances prior to employment being confirmed. The successful candidate must pass a criminal background check prior to employment.

The successful candidate must complete a PPD test.

Applicants must submit letter of interest, resume, and supporting documents (certificates, degrees, licenses). Applicants that are eligible for native preference must include Tribal Identification Card, Status Card or letter to be eligible for Native Preference. All submissions can be emailed to human.resources@srmt-nsn.gov or by mail to Human Resources, Saint Regis Mohawk Tribe, 71 Margaret Terrance Memorial Way, Akwesasne, NY 13655. Due to our network security, we are unable to open hyperlinks. Applicants will need to attach their documents as a PDF or WORD files if emailing. Applicants must clearly outline that they meet the qualification requirements on their resume.

NATIVE PREFERENCE POLICY

The Saint Regis Mohawk Tribe strives to be an equal opportunity employer dedicated to the policy of nondiscrimination based on race, sex, marital status, sexual orientation, religion, national origin, age, physical disability, veteran status or any other non-job-related factor. Among qualified applicants, the SRMT will give preference to the qualified native applicant.

DRUG TESTING POLICY

All positions require the successful candidate to pass a drug test for illegal substances prior to employment being confirmed.

BACKGROUND CHECK

Some positions require candidate(s) to successfully pass a criminal background check prior to beginning employment, used solely for employment related purposes. Depending on the position there maybe multiple background checks.

ELIGIBILITY LIST

A list of qualified candidates is created from interviews that may be used for Emergency Hire individuals to similar positions within the Saint Regis Mohawk Tribe for a period of six months.

INTERVIEW

Testing in the applicable skills may be required as part of the interview process.

EMPLOYEE COVID VACCINATION POLICY

The Saint Regis Mohawk Tribe Health Services has adopted a “Vaccination Policy” that requires ONLY Health Service employees to be “Fully Vaccinated” against the Coronavirus. The Vaccine requirement DOES NOT apply to positions that are not Health Services employees. Health Service Applicants are not required to disclose their vaccination status at the time of application; however, they must do so upon becoming the successful candidate. The successful applicant must submit their proof of vaccination status or they may submit a Medical Exemption form upon being notified that they are the successful candidate. At that point, the policy will apply to them as though they were already employed.