This role is essential in overseeing the referral process for patients referred to Billings Clinic from both internal and external providers across all service lines, working to enhance relationships regionally. The position requires impeccable interpersonal skills and a strong commitment to customer service, as it serves as a critical link between patients, providers, and various departments. You will collaborate across the region to improve communication and facilitate patient care, serving both internal teams and external partners to ensure seamless referral coordination.
Essential Job Functions • Serve as the primary point of contact for internal and external stakeholders regarding all patient referrals made to Billings Clinic, collaborating with service lines across the region to ensure seamless coordination and improve regional relations. Act as the system navigator and liaison for patients and families, addressing their questions and concerns, and providing guidance throughout the referral process.
Maintain accurate tracking and documentation of patient referrals to ensure visibility across teams, promoting patient safety and clear communication between departments. Ensure accurate registration processes, including verification of patient demographics and insurance information, to facilitate smooth referral handling. Collect and compile relevant clinical information regarding the patient’s medical background and referral needs, sharing appropriate details with specialists according to referral guidelines.
Assess incoming referrals to prioritize cases based on urgency and clinical needs, ensuring timely access to care and preventing delays that could negatively impact patient outcomes. Identify and address any referral issues that could adversely affect patient care. Work proactively to implement solutions that promote timely and effective treatment, ensuring high-quality service for all patients.
Clearly review referral details and expectations with patients, ensuring they understand the process and timelines. Ensure that referrals are addressed promptly and that all required documentation, including authorizations, is accurately recorded within the required timeframes. Prioritize incoming authorization requests based on urgency, ensuring critical cases are handled swiftly and effectively.
Regularly review and analyze referral data to identify trends and areas for improvement in workflows. Recommend adjustments to enhance process efficiency, reduce bottlenecks, and support consistent patient care. Maintain clear and consistent communication with external stakeholders, including provider offices and departments, regarding the status of referrals and authorizations, using systems such as Cerner to track and report referral progress.
Assist with retroactive authorizations, collaborating with provider offices or payers and communicating outcomes to the appropriate parties. Coordinate the resolution of issues related to the authorization process, conducting necessary research and problem-solving to resolve any discrepancies or challenges. Collaborate with Payer Relations and the referral manager to ensure all regional sites have the necessary agreements with external providers, improving overall regional collaboration.
Maintain up-to-date reference manuals, policies, workflows, and payer-specific requirements related to referrals, pre-certifications, and authorizations, ensuring data integrity and compliance. Provide orientation and education to physicians, nursing staff, Patient Financial Services, and other relevant personnel on referral processes, ensuring that all staff are informed and aligned with Billings Clinic’s procedures.
Ensure compliance with all organizational, departmental, and regulatory safety standards, supporting the safety and integrity of both patient care and departmental operations. Supports and models behaviors consistent with Billings Clinic’s mission, vision, values, code of business conduct and service expectations. Meets all mandatory organizational and departmental requirements.
Maintains competency in all organizational, departmental and outside agency standards as it relates to the environment, employee, patient safety or job performance. Performs all other duties as assigned or as needed to meet the needs of the department/organization.
- Education
- 4 Year / Bachelors Degree or an equivalent combination of education and experience relating to the above tasks, knowledge, skills and abilities will be considered. Experience
- 2 years of relevant experience, preferably in a healthcare setting.
- 1 year of experience at Billings Clinic, preferred.
- Proven ability to manage referral processes, including pre-certifications, pre-authorizations, and appointment scheduling, is highly desirable.
- Experience working with various stakeholders, including patients, healthcare providers, and external partners, to ensure seamless coordination of care.
- Familiarity with EHR systems, particularly Cerner, and knowledge of insurance processes, preferred. Certifications and Licenses
- Current Montana/Wyoming driver’s license and the ability to be insured to operate Billings Clinic vehicles