Referrals Supervisor

Hawaii Island Community Health Center

Job Title: Referrals Supervisor

Supervised by: Health Services Manager

Position Function SUMMARY:

Under the general direction of the Health Services Manager, the Referrals Supervisor has the general responsibility of supervising the Referrals Specialists in processing and managing external patient referrals and follow-up in collaboration with the provider and other members of the patient care team. Also assists in maintaining electronic patient files, responding to, and fulfilling requests for medical records and collection of data if related to a referral order and coordinating travel for patients to and from appointments.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

This position may have various work assignments within HICHC. This description is intended to be generic in nature, and as such it does not detail all duties and responsibilities of the job assignment. Various duties, responsibilities and accountabilities may be assigned to an incumbent in this position depending on the specific job assignment, and may include but not be limited to the following:

Referral Duties

• Facilitates processing of specialty medical, diagnostic, and therapeutic services to patients via appropriate referral workflows.
• Ensures referrals, preauthorization, and follow-up is coordinated with appropriate external resources.
• As needed, contacts specialists and insurance companies to ensure prior authorization approval requirements are met for referrals to specialists, diagnostic testing, and other services as deemed necessary per patient’s insurance company protocol. Provides necessary medical information such as history, diagnosis, and prognosis and advises the ordering provider if the authorization request is denied.
• Demonstrates competency in managed care preauthorization for travel.
• Applies age-specific and cultural considerations to referral process.
• Prioritizes patient referrals for maximum efficiency and optimum care provision.
• Communicates accurate and pertinent information with patient care providers and other members of the care delivery team to facilitate effective and efficient patient referrals and tracking.
• Demonstrates appropriate utilization and documentation in patient electronic medical records within the scope of responsibility of the referrals department.
• Demonstrates positive interpersonal relations in dealing with physicians, patients, patient families, visitors, and co-workers, in a professional and confidential manner.
• Participates as an active team member on the patient care team.
• Documents appropriately in the patient medical record in a timely manner, recording all written and verbal communication related to referrals.
• Maintains a safe, clean, and confidential working environment consistent with OSHA, HIPAA, and HHC standards.
• Embraces the philosophy of continuous quality improvement.
• Participates in continuing education activities.
• Manages changes in work demand during the workday.
• Ensures high quality customer service and patient/family satisfaction with referral services.
• Keeps supervisor informed of problems or issues.

Supervisory Duties

• Works with the Health Services Manager to ensure there is an integrated healthcare delivery system that is efficient, effective, and timely with appropriate response to patient and community needs in a variety of settings.
• Assists the Health Services Manager with making staffing assignments.
• Supervises and evaluates the quality of care delivered.
• Develops and maintains a tracking system for referrals to outside resources.
• Monitors the Referral department productivity and work assignments and adjusts as needed to distribute work equitably within the department.
• Actively participates in risk management programs to reduce errors, mitigate risk, and assist with investigations and information-seeking activities for program improvement.
• In coordination with Quality Improvement team provides leadership for continuous quality improvement efforts. Implements and/or updates processes for data collection, tracking and documenting activities.
• Provides leadership to ensure the highest standards of excellence in customer service by anticipating and responding to needs of internal and external partners; proactively works to improve the quality of customer service.
• Provides support activities performed by the Health Services Department by acknowledging, adhering to, and implementing organizational policies and standard operating procedures.
• Leads personnel in such a manner as to promote a productive, efficient, and safe working environment; establishes an effective flow of communication and information to ensure that problems can be resolved in a timely, effective manner and that support is provided to staff as needed.
• In coordination with the Health Services Manager, is responsible for the selection, assignment, training, and development of assigned direct report personnel.
• Ensures implementation of an effective performance management process for all direct report staff that clearly defines performance expectations and measures, including goal and objective setting, performance feedback, accountability measures, and corrective action as appropriate, and in compliance with sound management practices and applicable laws and regulations to ensure high levels of organizational, work unit, and individual performance.
• Actively seeks continuing education and training tools to support best practices for program and staff development and shares information through staff in-service training and individual performance improvement training. Conducts and documents regular team meetings.
• Manages inventory to ensure that necessary supplies are ordered and available, are properly stored and maintained, while seeking ways to reduce waste of resources and supplies.
• Ensures regulatory compliance of HIPAA by monitoring the workplace environment, on- and off-site staff activities and patient care services provided. Identifies areas where improvement or training is needed.
• Handles patient complaints and/or questions related to the Referrals department, addresses appropriately or forwards to Health Services Manager or DCO expeditiously.
• Develops, reviews and updates policies, standard operating procedures and documentation tools as required to perform services in a variety of settings in collaboration with the Health Services Manager, DCO, and Medical Director.
• Ensures timesheets and PTO requests are entered in ADP, monitored, and approved in a timely manner in coordination with the payroll department.
• Completes other projects and duties as assigned by Health Services Manager, DCO, COO, and CEO.

This individual must be able to effectively communicate both in written and oral form. This person must be capable of prioritizing and organizing tasks related to patient care. The Referrals Supervisor is expected to support the Health Center's mission and adhere to Health Center policies and procedures, as well as applicable state and federal regulations. He/she is expected to demonstrate superior organization, ability to multi-task, have effective interpersonal skills and be an active part of the patient care team.

POSITION SPECIFICATIONS:

Requirements of Position

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.

Education and Experience:

• High School graduate or GED certificate.
• One year of related clinical office experience and/or training is required; OR any equivalent combination of experience, training and/or education.
• Desirable experience includes:
• Familiarity with QUEST and other insurance programs
• Familiarity with Hawai’i health care networks
• Knowledge of ICD-10 and CPT coding

Knowledge, Skills and Abilities:

• This position requires a basic knowledge of general office procedures to include filing, copying, and faxing.
• Ability to use a computer to enter patient data and retrieve information.
• Ability to work on multiple tasks within established deadlines.
• Ability to work under the direction of a supervisor and follow instructions.
• Ability to take the initiative to resolve patient concerns and problems.
• Knowledge of patient chart documentation.
• Ability to communicate effectively in written and oral form with a diverse population.
• Demonstrate above average organizational capabilities.
• Demonstrate above average teamwork capabilities.
• Ability to multitask in a supportive patient care role to a diverse population.

Language Skills:

• Ability to read and interpret documents such as government regulations and guidelines, patient records, operating and maintenance instructions, procedure manuals, etc.
• Ability to write at a minimal level of competence, including internal reports and memoranda.
• Ability to communicate with diverse groups of people to include staff and providers and patients.
• Ability to communicate effectively with patients and their families to make their visit a pleasant experience.
• Sensitivity to the multicultural nature of the service area population and may be required to assist patients using interpreter services.

Personal Characteristics:

Personal characteristics include: a team player, high integrity, communication and customer relations skills, regular work attendance, courteous and friendly, able to work well with diverse groups of people, gain and maintain respect of others, accept HICHC mission and values.