Referral Clerk - Referral Coordinators

Description

JOB DUTIES INCLUDE, BUT ARE NOT LIMITIED TO:

The contract Referral Coordinator shall perform the following functions within the scope of accepted industry practices.  This list of tasks is not intended to establish either a maximum or minimum acceptable level of effort or be an inclusive listing of anticipated tasks.  Referral Coordinators provided by the

• contractor shall perform essentially the same services as those required by any MHS or government service Referral Coordinator professional of similar experience, in similar duty assignments and within their scope of practice.
• The contract Referral Coordinator will be required to attend and participate in meetings and professional staff conferences and other appropriate professional activities such as, but not limited to the following: Quality Improvement meeting, professional staff meetings, Department meetings, and others required by applicable regulations, MTF guidance, or as directed by the Commander, VMC-SA or his/her designated representative.
• The contract Referral Coordinator will be required to participate in special event informational seminars as directed by the Commander VMC-SA or his/her designated representative.
• The contract Referral Coordinator will provide assistance and monitoring to eligible beneficiaries by reviews, coordinates, and tracks Virtual Healthcare referrals, urgent/ASAP referrals, and VA-DoD sharing referrals.  Serves as the focal point for the coordination of health care services through reviewing of covered benefits, conducting CHCS and DEERS eligibility checks, ensuring administrative completeness, and monitoring, maintaining, and tracking of referrals.
• Enters in database system documentation on processing/research of each referral and status of each referral.  Assists physicians with proper documentation and preparation of required forms.  Serves as intermediary between the BAMC physicians, patients, and outside health care agencies and individuals in arranging for services and obtaining the necessary consultations and required authorizations.
• This position has the responsibility for coordinating, monitoring, tracking, health care referrals for the beneficiary population, to include Active Duty, Tricare Prime, Tricare Standard, Tricare for Life, and Tricare Plus, VA-eligible and MEDICARE.
• When potential delays may compromise the patient’s condition, coordinates with appropriate medical authorities to find alternative sources of care.  Contacts patients, if necessary, in the event the referral requests are invalid or disapproved and instructs patients on options.
• Maintain patient privacy and confidentiality.
• Keeps abreast of policy changes and current health care information and maintains pertinent records and files.
• Provides information on covered health care services and services excluded from the project and how these benefits integrate with other health care sources.

The employee accomplishes various duties to provide essential office

Qualifications

QUALIFICATIONS:

• A fully qualified typist with a minimum of 50 WPM is required.
• General medical ethics, telephone etiquette, and excellent communication and customer service skills.
• General office administrative and clerical skills to perform receptionist duties and answer telephones.
• Ability to communicate effectively, both orally and in writing.
• Education. High school diploma or General Educational Development (GED) equivalency. Completion of an Administrative Assistant program is desired.
• Experience. At least 6 months of experience in medical office setting.