MFM- Referral Specialist

Kaweah Health is a publicly owned, community healthcare organization that provides comprehensive health services to the greater Visalia area in central California. With more than 5,000 employees, Kaweah Health provides state-of-the-art medicine and high-quality preventive services in our acute care hospital, specialized health centers and clinics. Our eight-campus healthcare district has 613 beds and offers comprehensive health services across a broad continuum of care.   

It takes a special person to work for Kaweah Health. We serve a region where the needs are great, which makes the rewards even greater. Every day, we care for people facing unique challenges and in need of healing. Throughout it all, our focus is to make a difference, and we do — in the health of our patients, our loved ones, and our community.

Benefits Eligible

Full-Time Benefit Eligible

Work Shift

Day - 8 Hour or less Shift (United States of America)

Department

7198 KH Medical Clinic - Maternal Fetal Medicine

Coordination of patient care to specialist, ancillary services and lab/diagnostic services.

QUALIFICATIONS

Education
Required: High school diploma


Experience
Required: Minimum of one year medical terminology and medical services experience and health care background.

Preferred: Experience with diagnosis and procedure coding. Experience with insurance plans.

Knowledge/Skills/Abilities
Competency working in electronic systems.
Excellent phone communication skills.
Working knowledge of insurance plans common to the patient population.
Working knowledge of local and regional provider community resources.

JOB RESPONSIBILITIES
Essential

Effectively utilizes work lists to manage daily work priorities.

Accurately documents all referral work– status, updates and follow up according to organizational policy, using organizational tools and processes as prescribed.

Is responsive and communicates with the providers and clinical team regarding the referral status as desired/requested by the clinical team and as needed to ensure timely processing of referrals.

Returns calls from patients, the clinical team, referral sources, and insurance companies timely and with needed information, facilitating referral needs, appointment information or follow up on consult note as needed to complete the entire referral process as timely as possible.

Accesses insurance portals effectively to manage authorization requests.

Once authorization is obtained, makes patient appointment for KD services; for outside sources communicates referred provider and patient that authorization was obtained and instructs patient on provider appointment process when needed to assure patient is informed.

Provides referred provider with complete information to ensure timely response and follow through on the patient referral; for internal KD referrals the preferred method of communication is via EMR for status updates.

Utilizes organizational tools for referral process correctly to ensure patient information is available and to safeguard patient information appropriately.

Maintains timely referral follow up as prescribed by organizational policy and standards.

Communicates patient engagement concerns to unit leaders when needed. Documents referral follow through as assigned, including patient no show or receiving the consult note, notify the referring practitioner.

Works collaboratively with the referral team in re-assignments, covering absences and other workload changes, when requested and reassigned.

Participates in utilization management and performance improvement activities.


Additional

Demonstrates the knowledge and skills necessary to provide care and services appropriate to the population served on the assigned unit or work area.

Performs other duties as assigned.

Pay Range

$22.04 -$33.06

If you want to use your talents alongside people who face each day with courage and purpose, in an environment that empowers you to do your absolute best, this is where you belong.