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UnityPoint Health Referral Specialist in Cedar Rapids, Iowa

The Referral Specialist will coordinate all patient referrals at the request of the providers, obtain/review pre-authorization/pre-certification, coordinate communications with physician offices, companies, third-party payers and case managers; documenting appropriately within the medical record. The Referral Specialist will ensure appropriate appointments and follow-up appointments in the department following referral requests/visits and ensure documentation from specialists/offices is obtained, filed in the chart and forwarded to companies/payers as appropriate. The Referral Specialist will assist in clinical area and/or perform patient registration tasks and procedures as trained and requested.

Referral Coordination

• Responsible for the accurate and timely referral and scheduling of each workers’ compensation referral request. Initiates all referral requests within 24 hours on business days. Returns all calls promptly generally within the same day. Documenting all stages of the referral process within all EMR programs and communicating to the appropriate people regarding injury case.

• Coordinate and schedule of specialty exams within clinic as necessary.

• Obtains and/or documents approvals from Third-Party Payers for payment for services as directed or indicated via protocols.

• Documents all stages of the referral process in accordance with Department protocols.

• Monitors clinical voice mail and forwards messages to appropriate parties as appropriate.

• Monitors incoming faxes and ensures that they are distributed to appropriate staff/providers.

• Performs coordination of activities including, but not limited to Occupational Medicine visits, follow up with employees.

• Assists in coordinating care between patient, employer, insurance company, Work Well Clinic, Urgent Cares, Emergency Department, and other sites of care when needed.

• Acts as a liaison between St. Luke’s Work Well Clinic and all referral sources.

• Tracks referrals as required by Manager. Maintains and prepares referral reports.

• Performs functions other than described due to extenuating circumstances. 70%

Patient Care/Patient Care Support

• May be cross-trained to assist in clinical areas when needed. May be required to assist in clinic, drug testing, or onsite within scope of training.

• Perform miscellaneous back up patient service representative activities as directed by Manager/Supervisor.

• Participates in Quality Improvement initiatives.

• Demonstrates initiative to improve quality and customer service by striving to exceed customer expectations.

• Balance team and individual responsibilities; be open and objective to other’s views; give and welcome feedback; contribute to positive team goals; and put the success of the team above own interests.

• Demonstrates the knowledge that patient and workplace safety is a priority by preventing errors, accidents and infections and reporting potential or actual concerns immediately.

• Reflects knowledge of OSHA, DOT, Iowa Code for Workman’s’ Compensation, and other federal/state regulatory agencies guiding occupational medicine.

• Demonstrates the ability to meet the department work schedule.

• Demonstrates the knowledge that patient and workplace safety is a priority by preventing errors, accidents and infections and reporting potential or actual concerns immediately.

20%

Basic UPH Performance Criteria

• Demonstrates the UnityPoint Health Values and Standards of Behaviors as well as adheres to policies and procedures and safety guidelines.

• Demonstrates ability to meet business needs of department with regular, reliable attendance.

• Employee maintains current licenses and/or certifications required for the position.

• Practices and reflects knowledge of HIPAA, TJC, DNV, OSHA and other federal/state regulatory agencies guiding healthcare.

• Completes all annual education and competency requirements within the calendar year.

• Is knowledgeable of hospital and department compliance requirements for federally funded healthcare programs (e.g. Medicare and Medicaid) regarding fraud, waste and abuse. Brings any questions or concerns regarding compliance to the immediate attention of hospital administrative staff. Takes appropriate action on concerns reported by department staff related to compliance.

10%

Disclaimer: This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that required of the employee. Other duties, responsibilities and activities may change or be assigned at any time with or without notice.

Demonstration of UPH Values and Standards of Behaviors

Consistently demonstrates UnityPoint Health’s values in the performance of job duties and responsibilities

Foster Unity: • Leverage the skills and abilities of each person to enable great teams.

• Collaborate across departments, facilities, business units and regions.

• Seek to understand and are open to diverse thoughts and perspectives.

Own The Moment:

• Connect with each person treating them with courtesy, compassion, empathy and respect

• Enthusiastically engage in our work.

• Accountable for our individual actions and our team performance.

• Responsible for solving problems regardless of the origin.

Champion Excellence: • Commit to the best outcomes and highest quality.

• Have a relentless focus on exceeding expectations.

• Believe in sharing our results, learning from our mistakes and celebrating our successes.

Seize Opportunities: • Embrace and promote innovation and transformation.

• Create partnerships that improve care delivery in our communities.

• Have the courage to challenge the status quo.

QUALIFICATIONS:

Minimum Requirements

Identify items that are minimally required to perform the essential functions of this position. Preferred or Specialized

Not required to perform the essential functions of the position.

Education:

• High School Diploma or equivalent • Certified Medical Assistant, Medical Assistant with on-the-job training, or completion of Medical Administrative Secretarial course, a health care related course or degree

• Completion of medical terminology coursework

Experience:

• 1- 3 years of experience in a clinical office setting.

• Prior experience in an occupational health clinic

• Prior experience as referral specialist or with referrals and prior authorizations in a clinic setting

License(s)/Certification(s):

• Valid driver’s license when driving any vehicle for work-related reasons.

Knowledge/Skills/Abilities:

• Basic knowledge of medical terminology, anatomy, and physiology.

• Demonstrated training knowledge of medical terminology.

• Must demonstrate proficiency with computers, Microsoft Word, Excel Spreadsheets, and Outlook.

• Ability to read, write and speak fluent English, easily understood by others.

• Must be flexible to learn additional IT applications as assigned.

Other:

• Use of usual and customary equipment used to perform essential functions of the position.

• Work may occasionally require travel to other UPH facilities or outreach locations. May be required to drive a UPH vehicle, rental, or own vehicle.

SCOPE: Position has supervisory responsibilities? Yes ? or No ? If yes, complete below.

Number of Employees Supervised (Complete if position has supervisory responsibilities of individuals)

Direct Indirect Total

Exempt

Non-Exempt

Total

Budget Control (Complete if position has budget responsibilities)

Annual Operating Budget (including payroll)

Annual Revenue/Sales

Other Scope Measurements

Pertinent to the position, such as number of beds, number of units/departments, number of employees leading, cases per month, etc.

Item Number

Mental/Cognitive Demands:

(List any special mental and cognitive abilities required by the position in your specific environment)

• Ability to understand written, visual and other sensory stimuli

• Ability to work under time constraints

• Ability to understand and deal effectively with problems and opportunities

• Ability to deal with people effectively, patiently and respond professionally in all situations

• Ability to maintain confidential information

• Must be able to communicate effectively with people of diverse, professional, educational and lifestyle backgrounds

• Must be able to work independently and assume responsibility for timely completing of assigned functions

• Exercises sound judgement, seeking advice when appropriate

• Performs effectively under stressful situations

WORKING CONDITIONS:

Physical Requirements

(Check all that apply if essential to perform job – with or without accommodations)

? Talk/Hear (communicate, detect, converse with, discern, convey, express oneself, exchange information)

? See (defect, determine, perceive, identify, recognize, judge, observe, inspect, estimate, assess)

? Stand or Sit (stationary position)

? Walk (move, traverse)

? Use hands/fingers to handle or feel (operate, activate, use, prepare, inspect, place, detect, position)

? Climb (stairs/ladders) or Balance (ascent/descent, work stop, traverse)

? Bend/Stoop/Kneel

? Squat/Crouch/Crawl

? Reaching/Twisting

? Taste/Smell (detect, distinguish, determine)

? Pushing/Pulling

Lifting Requirements

(Check appropriate category to perform job – with or without accommodations)

? Level 1; Sedentary Work: Exerting up to 10 pounds of force occasionally, and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally, and all other sedentary criteria are met.

? Level 2; Light Work: Exerting up to 20 pounds of force occasionally or up to 10 pounds of force frequently, and/or a negligible amount of force constantly to move objects. Requires walking or standing to a significant degree, pushing or pulling arm or leg controls or maintaining a production rate pace. Light work requires physical exertion of forces greater than that of sedentary work.

? Level 3; Medium Work: Exerting up to 50 pounds of force occasionally, and/or up to 20 pounds of force frequently, and/or up to 10 pounds of force constantly to move objects.

? Level 4; Heavy Work: Exerting up to 100 pounds of force occasionally, and/or up to 50 pounds of force frequently, and/or up to 20 pounds of force constantly to move objects.

? Level 5; Very Heavy Work: Exerting in excess of 100 pounds of forces occasionally, and/or in excess of 50 pounds of force constantly to move objects.

Hazards and Atmospheric Conditions

(check all that apply)

? Normal Office Surroundings

? Vibration

? Exposure to Fumes

? Mechanical Hazards

? Exposure to Dust

? Chemical Hazards

? Exposure to Extreme Temperatures

? Electrical Hazards

? Wet and/or Humid

? Radiant Energy Hazards

? Noise

? Explosives Hazards

? Mists or Gases

? Burn Hazards

Other/Comments:

Precautions must be followed when working in any health care environment.

OSHA Categories

(Complete this OSHA section for clinical/patient related jobs)

? Category I: Duties performed routinely require exposure to blood, body fluid and tissue.

? Category II: Normal routine involves no exposure to blood, body fluid or tissue, but exposure or potential for exposure may occur.

? Category III: Normal routine involves no exposure to blood, body fluid, or tissue and as part of their employment, incumbents are not called upon to perform or assist in emergency care or first aid.

Requisition ID: 2020-82622

Street: 830 First Ave NE

Name: 1010 UnityPoint Health CR St Lukes Hospital

Name: Occupational Hlth/Workwell

FTE (Numeric Only; Ex. 0.01): 1.0

Scheduled Hours/Shift: 7:00-4:30 PM

External Company URL: http://www.unitypoint.org

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