Referra Clerk

NATURE OF WORK:

The referral clerk is responsible for coordinating all service referrals for patients at Lincoln Primary Care/Southern West Viriginia Health System.

JOB REQUIREMENTS AND PREFERRED QUALIFICATIONS:

• High school diploma or (GED) equivalency.
• Two years of healthcare administrative experience in either an inpatient or outpatient care setting within the last three years is preferred.
• Ability to read, write and speak the English language.
• Experience in referral/patient navigation preferred.
• Prior experience with insurance companies.
• Confidentiality (according to HIPAA guidelines)
• Medical Terminology
• Computer Skills (Basic keyboarding and PC skills, use of printers/copiers, and fax equipment).
• Ability to demonstrate compassion and caring in dealing with others.
• Excellent customer service skills
• Good communications skills (spoken and written)
• Good critical thinking and problemsolving skills. Ability to plan, prioritize, and complete delegated tasks.
• Ability to work in a highvolume environment to obtain authorization, schedule, and track referrals electronically to completion.
• Ability to comply with LPCC/SWVHS and Division departmental safety procedures.
• Ability to maintain a professional manner even in challenging situations.
• Ability to work effectively as a team member with providers and other staff.

ESSENTIAL FUNCTIONS & RESPONSIBILITIES OF THE POSITION

• Ensures that referrals are addressed in a timely manner.
• Maintains ongoing tracking and appropriate documentation on referrals in the electronic medical records system to promote clinical team awareness and ensure patient safety.
• Contacts review organizations and insurance companies to ensure prior approval requirements are met.
• Accurately fills out consultant request and sends appropriate medical records to the specialist/insurance provider in a timely manner.
• Accurately enter notes into EMR System regarding letters or correspondence from insurance companies regarding insurance authorization or other notifications.
• Assembles information concerning patient's clinical background and referral needs.
• Assists with obtaining prior authorizations for all procedural orders by successfully completing the authorization process with all payers.
• Communicates with the referring provider if unable to obtain prior authorization for ordered testing.
• Communicates with the referring provider if unable to obtain appointment or if patient does not keep scheduled appointment.
• Processes written or verbal instructions from provider, including initiating requisitions, requesting appointments for diagnostic imaging, consultations, completing forms, and requesting additional documentation.
• Requests new referrals to be ordered when applicable.
• Ensures complete and accurate registration, including patient demographic and current insurance information.
• Routing documents for provider review as required.
• Keeps patients informed of their appointment dates/times.
• Assists patients in problem solving potential issues related to the health care system, financial or social barriers (e.g., request interpreters as appropriate, transportation services or prescription assistance).
• Point of contact for patients and specialists for any questions or rising concerns. If unable to help, assist in finding the right point of contact for further help.
• Serves as the system navigator and point of contact for patients and families and may assume an advocate role on the patient's behalf with the carrier to ensure approval of the necessary supplies/services for the patient in a timely fashion.
• Identifies and utilizes cultural and community resources, establishing and maintaining relationships with service providers (e.g., DME, Home Health, Oxygen companies) and keeping an updated list of referral providers and facilities.
• Ensures that patient's primary care chart is up to date with information on specialist consults, hospitalizations, ER visits and community organization related to their health.
• Attends inservice trainings and mandated meetings as assigned.
• This is not an allinclusive job description; therefore, management has the right to assign or reassign schedules, duties, and responsibilities to this job at any time.