What are the responsibilities and job description for the Clinical Referral Specialist position at Sixteenth Street Community Health Centers?
- Reviews work queues to identify unscheduled ordered services and connects with the patient to schedule the appropriate service.
- Knowledgeable of Medicare, Medicaid and third-party payer requirements, guidelines and policies, insurance plans requiring pre-authorization and current accepted insurance plans.
- Responsible for notifying the ordering provider through referral in basket message in electronic health record when an ordered medical service is removed according to the department’s assigned removal reasons.
- Provides the highest level of patient service by problem solving, documenting patient concerns, and identifying appropriate follow-up for patients.
- Understands the process of authorization requirements, payer coverage, eligibility guidelines, and Charity Care systems.
- Is a liaison between patients and registration department to assist in updating demographic, financial, and insurance information.
- Seek timely approval of referrals by providers.
- Track approvals and denials of prior authorizations in work queues and maintain trail of referral outcomes via EMR.
- Communicate approvals and denials with patients, clinical teams via referral in basket message and Specialist offices as needed and requested.
- Act as a direct resource for clinical teams as it pertains to initiating referrals, obtaining authorizations for referrals, and maintaining referral source information.
- Act as a direct contact and information source for patients navigating their insurance or Charity Care systems as it pertains to referrals.
- Timely maintenance of other resources to assist clinical teams as it pertains to initiating referrals and obtaining authorizations for referrals.
- Data entry for statistical reporting of referrals and related work.
- Comply with SSCHC TB Control Plan including PPD testing.
- Perform other duties as assigned.
QUALIFICATIONS:
- Minimum of 1 year of work experience in a health care environment. Previous referral department employment preferred.
- Medical terminology.
- Excellent oral and written communication skills.
- Strong Customer service skills.
- Ability to manage multiple tasks.
- Knowledge of basic office computer programs and typing are essential.
- Ability to relate well to people from diverse ethnic and cultural backgrounds.
- Bilingual (Spanish/English) required.
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