Referrals Clerk Operator-Temporary

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.

Under direction of the Referrals & Authorization Supervisor, the Referrals & Authorization Clerk Operator works closely with patients, Referral & Authorization Clerks, health plans, external health centers and specialists. The Referrals & Authorization Clerk Operator is primarily responsible for answering and screening all referral related phone calls and communicating real time updates to help with the coordination of specialty referrals. This is a full-time, temporary role, expected to last about 3 months.

Responsibilities

Direct Patient Care

• Screen and answer all referral related calls through call queue via Talkdesk program and assist patients and specialty vendors.
• Referral & Authorization Clerk Operator will also assist with refaxing referrals and/or process redirections through health plans including but limited to completing the entire process of a lifecycle of a referral.
• Communicate appointment and real-time status updates of a referral and provide referral demographics to patient/family.
• Discuss with patients all aspects of the referral process as needed or requested by the treating provider. This may include counseling the patient regarding the cost of a referral under provider direction.
• Performs eligibility checks as necessary electronically and/or via telephone
• Patient communication by telephone, via MyCare, SMS text messaging, and/or by mail.
• Act as a liaison between patients, referral & authorization clerks, clinic/providers, specialty care providers, health plans/funding sources, and community resources.
• Positively impact patient experience by demonstrating values of Transforming Care including, but not limited to, utilizing AIDET as preferred method of communication maintaining courteous, kind, patient and helpful behavior and a commitment to accuracy.
• Deliver outstanding customer service while maintaining a positive tone and approach.
• Utilize de-escalation skills to address and resolve challenging conversations, identifying key points and providing appropriate solutions based on referral policies and workflows.
• 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 solutions and next steps to patient and referring provider.

Provider & Team Support

• Screen calls to the best of ability to assist assigned provider Referral and Authorization Clerk with the necessary details to complete the task requested that is needed by specialist or patient.
• Collaborate with Referral & Authorization Clerks to continuously improve service delivery and patient experience.
• Obtain and check the status of authorizations where applicable.
• Assist and actively participate with all referrals related programs
• Process direct referrals to its entirety and help to distribute generic tasks via EMR when call volumes decrease
• Communicate referral/authorization information and pertinent medical information to the specialty provider.
• Obtain the consult/progress reports from the specialty provider, radiologist, etc.
• Appropriate documentation in the patient’s medical records.
• Maintain accurate lists of specialists/providers by funding source and other community resources as approved by the Medical Director and/or supervisor.
• Attend Health Plan Case Management operation meetings and MSO UM meetings on a rotating basis.
• Share accountability for overall patient health outcomes, working in coordination with Care Teams
• Schedules appointments as needed for internal specialty services.
• Function at highest level according to credentials and competency.
• Other duties as assigned

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
• Display knowledge of normal signs of human development and ability to assess and provide age-appropriate care.
• Contribute to the success of the organization by participating in quality improvement activities

Qualifications

Education/Experience

• High School Diploma/GED required.
• Bilingual (English/Spanish) required (Must pass Language Proficiency Test).
• One year patient services/referrals experience and/or call centers 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 benefits package to all full-time, temporary employees which includes: holiday pay, sick pay, comprehensive medical, dental and vision plans, a 403(b)-retirement plan, Life/AD&D coverage, and more!

Pay range: $22.54  -$29.27 per hour, depending on experience.

Salary : $23 - $29