Patient Referral Automation

Led automation initiative that eliminated manual patient referral workflows, saving 2-3 hours per agent per week and improving compliance.

Patient Referral Automation

About the Project

I identified an opportunity to automate a manual patient referral workflow that was being carried out by the Customer Support (CS) team. The process involved filling out custom Word forms, sending them via secure email, and logging the entry into an internal CRM. This method was time-consuming, inconsistent across clients, and introduced compliance risks due to sensitive data being stored on local machines.

Goals:
  • Standardize the referral process across clients
  • Eliminate manual handling of Protected Health Information (PHI)
  • Improve turnaround time and reduce operational overhead
  • Increase contract compliance and client satisfaction

My Role

  • Initiated and led the entire automation initiative
  • Collaborated cross-functionally with CS, Analytics, Architecture, and Engineering
  • Drove stakeholder alignment, ROI analysis, and implementation through release

Program Management Approach

  • Discovery & Research:
    • Met with CS leadership to map out the existing referral workflow
    • Conducted interviews with Support Specialists to gather step-by-step inputs, time requirements, and pain points
    • Evaluated contract terms to understand referral SLAs, obligations, and revenue implications
  • Design & Feasibility:
    • Led the creation of a universal referral form that could be used across most clients
    • Partnered with Analytics to identify common data fields that would support reporting and optimization
    • Worked with the Software Architect to estimate build complexity and align on phased delivery
  • Business Case & Execution:
    • Built a strong ROI case based on time savings, productivity gains, and risk mitigation
    • Secured leadership buy-in for implementation
    • Delivered the feature in 4 sprints with UAT led in collaboration with the QA and CS teams
    • Provided training and internal documentation for CS adoption

Tech Details

Platform:
Internal CRM system integration with standardized digital referral forms accessible directly from customer profiles.
Form Design:
Standardized digital referral form accessible from customer profiles, replacing manual Word document processes.
Workflow:
Form submission triggers a case in CRM. Team Leads access submissions, validate data, and manually forward to insurance providers (initial phase).
Data Layer:
Captures referral data for analysis and tracking via backend reporting, enabling better visibility and optimization opportunities.
Compliance Risk Mitigation:
Eliminated local storage of PHI on agents' laptops by centralizing all data handling within the secure CRM environment.

Compliance

HIPAA Alignment:
Transitioned from local document handling to secure, centralized CRM-based form entry. Reduced PHI exposure and improved auditability of all patient referral activities.
HiTrust Considerations:
Process improvements aligned with HiTrust control objectives on data handling, least privilege access, and automation of sensitive workflows.

Outcomes

4
Sprints to delivery
2-3
Hours saved per agent per week
40%
Time reduction achieved
100%
Elimination of manual forms
PDF
Auto-generate PDF on approval for standardized document delivery
Additional Benefits:
  • Enabled CS team to increase referral throughput and meet client SLA requirements
  • Improved data standardization, operational efficiency, and CS team satisfaction
  • Enhanced compliance posture and reduced audit risk

Future Enhancements

Planned automation improvements to further streamline the entire workflow in CRM:

  • Built-in approval flow with digital sign-off capabilities
  • Automated delivery via SFTP to clients for seamless integration
  • Notifications for team leads and comprehensive audit trail integration