Referrals and Authorizations Clerk

Community health is about more than just vaccines and checkups. It’s about giving people the resources they need to live their best lives. At Neighborhood, this is our vision. A community where everyone is healthy and happy. We’re with you every step of the way, with the care you need for each of life’s chapters. At Neighborhood, we are Better Together.

As a private, non-profit 501(C) (3) community health organization, we serve over 506,563 medical, dental, and behavioral health visits from more than 96,867 people annually. We do this in pursuit of our mission to improve the health and happiness of the communities we serve by providing quality care to all, regardless of situation or circumstance.

We have been doing this since 1969 and it is our employees that make this mission a reality. Regardless of the role, our team focuses on being compassionate, having integrity, being professional, always collaborating, and consistently going above and beyond. If that sounds like an organization you want to be a part of, we would love to have you.

The primary responsibility of the Referrals and Authorizations Clerk is to coordinate all referrals and follow-up care for prenatal/OB clinic patients.  The clerk is also responsible for receiving, processing, scheduling, and following up on all medical referral requests, including in-house and outside referrals for diagnostic testing, medical specialists, or other providers.

Responsibilities

Direct Patient Care

• Performs eligibility checks as necessary electronically and/or via telephone
• Prepares, processes, and completes referrals accurately and in a timely manner
• Communicates referral details, appointment information and instructions to patient/family
• Tracks referrals in the designated logs and/or electronically via Electronic Medical Records (EMR)
• Follows up as needed on submitted authorization requests and maintains consistent status updates of efforts via EMR
• Monitors and reports on status of authorization requests, escalating issues as necessary, until fully resolved and referral loop is closed
• Proactively manages needs for re-authorization across all clients and payors, working closely with clinical teams to ensure timeliness re-authorization ahead of expiry to avoid lapses in authorization or delays in patient care
• Submits retro-authorizations and distinguishes between primary care and internal specialty visits
• Documents all actions taken in the patient medical record in accordance with current Clinic, DHS and health plan regulations/guidelines
• Advocates and discusses with patients all aspects of the referral process as needed or requested by the treating provider, including counseling patients regarding the cost of a referral, explaining insurance barriers and offering next step solutions to patient and referring provider
• Screens and answers related referral calls by telephone, text message, patient portal, and/or by mail
• Acts as a liaison between patient, clinic/providers, specialty care providers, health plans/funding sources, and community resources

Provider & Team Support:

• Assists assigned provider referral clerk with the necessary details to complete the task requested that is needed by specialist or patient
• Obtains referral and authorization from provider in timely manner
• Communicates referral and authorization information and pertinent medical information to the specialty provider
• Obtains consultation and/or progress reports from the specialty provider, radiologist, etc.,
• Participate in scheduled department meetings
• Share accountability for overall patient health outcomes, working in coordination with care teams

Customer Relations:

• Maintains a professional working relationship with all levels of staff, clients, and the public
• Cooperates, as part of a team, in accomplishing department goals and objectives
• Maintains positive relationships with all patients, prospective patients, clinical staff, prospective employees, fellow co-workers and referral sources

Qualifications

Education/Experience

• High school diploma/GED required
• Bilingual (English/Spanish) highly preferred 
• One year patient services/referrals experience in medical office environment preferred

 Additional Qualifications(Knowledge, Skills and Abilities)

• Knowledge of Current Procedural Terms (CPT), International Classification of Diseases (ICD-10), and medical terminology preferred
• Excellent verbal and written communication skills, including superior composition, typing and proofreading skills
• Ability to interpret a variety of instructions in written, oral, diagram, or schedule form
• Ability to successfully manage multiple tasks simultaneously
• Excellent planning and organizational ability
• Ability to meet close referral cycle times following communication of progress to internal and external entities
• Ability to work as part of a team as well as independently
• Ability to work with highly confidential information in a professional and ethical manner

 Neighborhood Healthcare offers a generous benefit plan that includes:  Partially company paid Medical, Dental, and Vision Plans. Two plus weeks of vacation, Nine Holidays including two Floating Holidays of your choosing, Sick/Personal time, Volunteer Time Off (VTO), 403b Retirement plan (similar to a 401k), optional Health and Wellness events, and much more!

Pay Range: $22.42 to $27.40 per hour, depending on experience.