MUHA - Referral Management Specialist I - Psychiatry

Job Description Summary

Under general supervision, the Referral Management Specialist I serves as the initial point of contact for individuals and referring physicians seeking access and referral information for medical care at MUSC. This position facilitates the referral process and schedules appointments for multiple specialties and primary care physicians in a call center environment utilizing an automated scheduling system. This role triages patient calls according to established algorithms, answers questions, resolves issues and refers to appropriate clinical team for clinical issues as appropriate. This position performs quality data collection of accurate information including demographic, physician, insurance, employment, next of kin, emergency contacts and other miscellaneous information needed to complete the patient’s information. This role performs activities to ensure effective operations of the clinics, while enhancing the revenue cycle and providing the highest level of customer service.

Entity

Medical University Hospital Authority (MUHA)

Worker Type

Employee

Worker Sub-Type​

Regular

Cost Center

CC000593 CHS - Patient Access Center

Pay Rate Type

Hourly

Pay Grade

Health-19

Scheduled Weekly Hours

40

Work Shift

Job Description

Entity: Medical University of Hospital Authority (MUHA)

FLSA: Hourly, Non-Exempt

Pay Frequency: Biweekly

Hours Per Week: 40

Job Responsibilities:

• 15% - Answers phone calls from patients, physicians, clinic personnel and others. Collects accurate information from caller to ensure a timely and accurate registration. This information includes demographic, insurance and referring and primary care information. Enters referral information in EPIC referral application to ensure services are authorized/or approved by insurance company. Utilizes departmental protocols and decision trees to determine result of each incoming call. Accurately assesses the call to determine if appointment is needed, nurse intervention is needed, medication refill is required, an immediate appointment is necessary, clinical messaging is necessary, a direct connection to the clinical staff is required, a need sooner appointment request is necessary, etc. Schedules appointments in an automated scheduling system per protocol. Coordinates most convenient appointment date and time with referring physician and/or patient. Ensures patient is in‐formed of appointment information, including time, place, directions, appt reminder information, etc. Coordinates printing and mailing of correspondence related to scheduling. Maintains skill base in other areas such as registration, pre-registration and others as needed through cross-training. Effectively messages clinic, department or individual if call is not appointment related. Possesses up-to-date knowledge of University, MUHA, and/or departmental activities in order to effectively assist patients with questions and requests. Demonstrates ability to transfer patients appropriately. Understands and demonstrates ability to meet stated goals for scheduling call center. These goals include: effectively answering 75+ plus calls per day (10 – 15 calls per hour/day on average) within 3 rings or 30 seconds, works as a team to achieve the overall goal of 92% answer rate and a < 2 minute total talk time and possesses ability to maintain the highest quality of customer service during peak call volumes.
• 15% - Cancels and reschedules patient appointments as necessary per protocol. Contacts patients by phone and/or mail to reschedule appointments. Possesses advanced scheduling knowledge and security to process a “bump” in IDX. This often includes bumping all patients from a particular date of service and working the online bump list to select a convenient date and time for the patient. This may involve reviewing bumped patient lists with clinic coordinator, provider and/or departmental staff. The scheduler must understand the urgency of each diagnosis and determine, clinical guidance, the better alternative for the patient. Often, the bumping process includes notifying ancillary services that clinic has been canceled.
• 15% - Keeps abreast of current events in order to answer questions and transfer calls appropriately. Schedules lab test, x-rays, and other ancillary tests and procedures as necessary and in coordination with physician visits. Performs other tasks as requested by supervisor. Completes tasks on time. Promotes teamwork by assisting coworkers in attaining common goals. Develops and maintains a good working relationship with the physicians, clinic staff, and other support staff. Acts as a liaison to referring physicians by providing accurate and consistent information in a timely manner.
• 15% - Maintains advanced knowledge of insurance. Verifies insurance information, appropriately enters information into EPIC and utilizes the precertification and referral features of EPIC. Actively participates in the obtaining and tracking of medical office referrals. Effectively communicates the need for insurance referrals to PCP and/or patient. Demonstrates the excellent follow-up skills to ensure that all medical and insurance information has been requested and/or received prior to the patient's appointment. Comments system effectively in order to communicate with coworkers with regard to the patient's account. Understands the impact accurate insurance information has on all downstream functions, including Central Verification Unit, Front Desk Operations, TES management and Charge Entry, Timely fi ling of claims and reducing delay in reimbursement. Additionally, understands individual impact they have on achieving organizational goal of cost reduction of 3.5%. The above directly impacts the “bottom-line.” By accurately entering information, the scheduling personnel reduce the need for “rework” and save considerable time, effort and dollars for the organization. Additionally, this increases customer satisfaction and improves our responses to our patient satisfaction survey.
• 15% - Maintains patient referral system. Communicates all steps of referral process to referring physicians and clinic staff. Informs the patients/physicians of all necessary referral authorizations and/or pre-certification requirements based on insurance coverage. Effectively documents refer‐ring physician information and communicates needs for additions to referring physician dictionary to UMA IS. The desired goal is to reduce referring physician “unknown” to less than 2% of all patients scheduled in EPIC. This ensures continuity of care with correct and appropriate referring/ordering physician. Accurate information in EPIC patient database ensures Marketing’s ability to obtain a quality assessment of the effectiveness of organizational wide marketing initiatives.
• 15% - Monitors clinic schedule to identify gaps, inappropriate time slots, inappropriate diagnosis for doctor, referring information, insurance and medical referral information, ensure necessary clinics have been removed from system, and overall efficient flow of patients. Ensures system proto‐cols match physician requested protocols and the actual schedule. Makes adjustments to schedule, based on findings, and communicates appropriately. Understands the importance of a correct schedule to promote an efficient clinic flow and maximize physician clinic time. Understands the impact this process has on patient wait times, registration processes and patient satisfaction. Has the ability to turn a potentially “negative” experience into an opportunity to provide excellent customer service through communication and coordination with the patient and internal customers, resulting in positive responses from patients to patient satisfaction survey question “would you recommend to others?” Possesses strong working relationships with departmental and clinical staff to ensure that these processes are complete timely and efficiently.
• 5% - Maintain compliance with federal and state regulations and organizational policies.
• 5% - Other duties as assigned.

Minimum Training and Education: High School Degree or Equivalent Work Experience: 0-6months

Preferred Training and Education: A Bachelor's degree from an accredited college/university; or a high school diploma or equivalent (GED) and two years’ experience in a Medical Office, Call Center, and/or customer service business environment required. The ability to prioritize and coordinate multiple tasks in a busy environment necessary. Extensive experience with computers and technology including Windows, Excel, and Intranet/Internet navigation tools, as well as system content, essential. Strong demonstrated verbal, written, problem solving and presentation skills. Ability to work in self-directed manner while interacting with customers, physicians and departmental partners. Typing speed of 35 cwpm is required. A certified typing test can be completed by SC WORKS and must be presented at time of interview or a typing test will be conducted on-site at time of interview.

Additional Job Description

Education: High School Degree or Equivalent Work Experience: 0-6months

If you like working with energetic enthusiastic individuals, you will enjoy your career with us!

The Medical University of South Carolina is an Equal Opportunity Employer. MUSC does not discriminate on the basis of race, color, religion or belief, age, sex, national origin, gender identity, sexual orientation, disability, protected veteran status, family or parental status, or any other status protected by state laws and/or federal regulations. All qualified applicants are encouraged to apply and will receive consideration for employment based upon applicable qualifications, merit and business need.

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