Referral Clerk

Job Title: Referral Clerk Department: Referral Center Reports To: Director of Utilization Management (UM) and Referrals FLSA Status: Non-Exempt Wage Range that the Company Expects to Pay: $22.50 - $24.81 per hour SUMMARY Under the direct supervision of the Director of UM and Referrals, the Referral Clerk is responsible for processing specialty referral orders by obtaining insurance authorization, attaching clinical documents, and submitting to specialty offices. The Referral Clerk communicates with patients about referral details and documents in the electronic health record. The Referral Clerk obtains specialist consultation notes and closes referrals. It is the primary purpose of CHCCC to provide the highest quality of total care possible to the patient population it serves. Such a level of quality depends ultimately on the staff's desire and ability to work together, individually, and as a team. The employee is expected to be professional, punctual, maintain regular attendance, cooperative, motivated, and organized at all times. ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Additional duties may be assigned with or without prior notice. Selects referrals from assigned site bucket, reviews referral order, and chart documents for appropriateness and completeness. Contacts patient to confirm referral and advises patient of referral detail. Obtains insurance authorization for referral and uploads into the electronic health record. Collates electronic documents relevant to referral order (chart notes, diagnostic studies, authorization) and submits to specialist. Documents actions in electronic health record. Selects follow up from assigned site bucket, reviews referral documentation, and looks for associated consultation notes in electronic health record. Contacts patient to confirm specialty appointment was made, kept, and notes date in electronic health record. Contacts specialty office to request consultation report, if indicated. Answers incoming telephone calls from patients or offices and addresses needs of the caller. Reviews and responds to patient cases as assigned. Completes chart processing and RAF requests as assigned from the Utilization Management bucket. Requests consultation notes and/or prescriptions for 340B claims as assigned. Demonstrates professionalism and provides quality customer service using AIDET Standards. Ability to work with high volume of patients, internal/external customers, and deal with frequent changes, delay or unexpected events. Demonstrates adherence to and observes all safety policies and procedures, inclusive of infection control rules and regulations. Demonstrates the knowledge and skills necessary to provide care appropriate to the age of the patients served (infants, pediatrics, adolescents, adults or geriatrics). Demonstrates knowledge of domestic violence, child and dependent abuse protocols. Demonstrates cultural sensitivity and competence with patients. Maintains and adheres to HIPAA, employee confidentiality, and privileged communications (patient, employee, and corporation). SUPERVISORY RESPONSIBILITIES This job has no supervisory responsibilities. QUALIFICATIONS 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. COMPETENCIES To perform the job successfully, an individual should demonstrate the following characteristics: resourceful, independence, detail-oriented, professionalism, problem-solver, multi-tasker, team player, and customer service. EDUCATION and/or EXPERIENCE High school diploma or GED required. Graduation from an accredited school in Medical Assisting or a certified or registered medical assistant (CMA/RMA), or other relevant medical experience. LANGUAGE SKILLS Ability to read and inte…