CLINICAL REFERRAL SPEC- PFAS

Overview
To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values—integrity, patient-centered, respect, accountability, and compassion—must guide what we do, as individuals and professionals, every day.

The Clinical Referral Specialist functions as the liaison between the referring physician and the patient in managing appointment and procedure scheduling. This individual works closely with patients, physicians and nurse professionals within the clinic setting. This individual is responsible for accurately managing and making decisions related to sequencing of complex radiology procedures, laboratory procedures, physician appointments, and infusion/chemotherapy appointments. The Clinical Referral Specialist communicates directly with the patient and/or the referring physician office to ensure instructions, preparations or laboratory test requirements prior to the procedure/appointment have been met. Individual will coordinate multiple patient appointments and manage patient and insurance demographics to ensure appropriate reimbursement for services provided. This individual will be responsible for making decisions around exams ordered as they relate to meeting Medical Necessity and follow up with patient and /or referring physician when a Waiver or ABN is required. Individual is cognizant of Imaging sites across the Enterprise and appropriately aligns appointments with patient locations. A major focus in completing these responsibilities will rely on the individual 's attention to detail, specificity and accuracy as it relates to the procedure, the appointment or the chemotherapy, the supporting documentation and an extraordinary level of patient sensitivity and compassion. Position requires the individual to maintain a high awareness of Service Excellence representing I am YNHH at all times and in all locations. Performs certain statistical and QA functions. Helps develop new procedures and participates in the planning and implementation of system improvements to enhance the operating functions of the department.

EEO/AA/Disability/Veteran

Responsibilities

  • 1. Ensures smooth and timely patient throughput: Ensures all required information is obtained from the referring physicians and providers in clinical areas, and provided to the third party payors to ensure reimbursement for services delivered within the outpatient setting.
    • 1.1 Accurately schedules patient follow up physician appointments in the appropriate scheduling system using guidelines and requirement identified within the system
  • 2. Coordinates and Supports tasks related to patient appointment Scheduling:
    • 2.1 Maintains a strong working knowledge of SCM, SCM Ambulatory, Imagecast, SDK, Centricity Logician , Patient tracking and IDX Flowcast
  • 3. Resource Management/Quality Assurance:
    • 3.1 Independently optimizes time related to patient appointment scheduling.
  • 4. Service Excellence:
    • 4.1 Demonstrates the ability to balance customer service with the financial needs of the hospital.

Qualifications

EDUCATION


Associate degree in Business or Healthcare sciences / Administration required or equivalent healthcare experience. Medical terminology, anatomy and Physiology courses required


EXPERIENCE


Minimum of Three (3) years relevant or equivalent experience in direct coordination and managing of patient appointment scheduling in an outpatient Healthcare environment required. Individual must have computer experience in such applications as Word, Excel, Powerpoint etc. Individual must have previous experience or education related to Third Party payor requirements and Medical Necessity as it relates to Imaging and Infusion appointments.


SPECIAL SKILLS


Excellent interpersonal skills, analytical abilities as it relates to the how and when of appointment sequencing, assessment of patient needs and urgency, and computer skills to assist with decision support. Incumbent must have the ability to effectively communicate with referring physicians and nursing professionals and leadership in identifying the patients clinical needs to maximize the coordination of the appointments to be scheduled. Individual must have the ability to problem solve and work independently in making decisions understanding position guidelines and expectations. Ability to search internet/utilize web-based on-line eligibility systems to obtain third party payor requirements.



See Inside the Office of Yale New Haven Hospital

Yale New Haven Hospital provides diverse comprehensive care in over 100 medical specialties. As the primary teaching hospital of the Yale School of Medicine, YNHH provides around-the-clock coverage and insightful, research-supported patient care. In addition to providing quality medical care to patients and families, Yale New Haven Hospital is the second largest employer in the New Haven area, with more than 12,000 employees.


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