REFERRAL CLERK

Description

GENERAL DESCRIPTION OF POSITION:

Process all medical referrals in accordance to SC referral policies and procedures that are essential in carrying out the patients’ health care plan.

Will perform all duties which involve interaction with a patient in a manner which ensures the patient has a pleasant and satisfactory experience.  All interactions with the patients will be in adherence to the PCMH principles, policies, and procedures.

ESSENTIAL JOB FUNCTIONS: (with or without accommodations)

Patient Communication: Inform patient of the referral recommendation by the physician and works with the patient regarding dates for appointments and the importance of keeping the appointment. If patient needs financial assistance, clerk will refer to the Social Workers.   Instruct patient of the appropriate instructions, as indicted by the appointment. 

Manages Appointments: Contact appropriate consultant’s office and arranges an appointment for the patient.

Obtains prior authorization for services, as needed.  Notifies patient of schedule appointment date and time.  Will conduct the majority of the authorizations and teach other new referral clerks how to conduct them.  Will also serve as mentor to other new referral clerks.  Maintain positive and effective communication with all referral clerks.

Team Communication: Consult with referring physician for appropriate follow up care.  Approaches patient care as a team involving clinical and non-clinical staff (example, Physicians, mid-levels, educators, appointments staff) to achieve patient care objectives, as needed.  Referral Clerk (RC) will attend meetings as required.  RC adheres to all HIPAA regulations in and outside of the Clinic.  Communicates patient information as requested to enhance patient services.   Will assist the Director of Social Services in conducting audits to make sure all referrals are addressed appropriately.

Management of Documentation: Utilize Athena One Physician Office referral process (EMR) to process all assigned referrals.  Convert daily doctor flags to referrals into patient chart.  Verify insurance coverage for patient.  Obtain authorization from insurance companies, Medicare, Medicaid PCCM in order for patient to attend their appointment.   Review and complete all invoices with a “referral stamp” and submits to the Chief Financial Officer for payment. Track patient’s appointments and confirms if patient kept their appointment.  Submit quick text to Medical Records indicating patient kept appointment.  Referral Clerk files, copies, and faxes medical referrals, as needed.

Demonstrates Safe and Professional Conduct: Maintains a friendly and safe environment for self and others.  Refrains from texting and speaking on cell phone while on duty.  Will maintain the phone on mute to avoid hearing the ringing of personal cell phones.  Refrains from informal communications with patients and others.  Attends work on a regular and predictable schedule in accordance with clinic leave policy and performs other duties assigned.

POSITION DIRECTLY SUPERVISED:  N/A

Qualifications

KNOWLEDGE, SKILLS, AND ABILITIES: (use of equipment, job related knowledge, language, etc.)

Skilled in the use of a computer.

Knowledge of PCMH Model

Knowledge of electronic medical records.

Knowledge of SC policies and procedures.

Knowledge of medical terminology.

Knowledge in providing effective Customer Service on a daily basis.

Knowledge of computer software (Microsoft Word, Excel, etc.) programs.

Knowledge in the use of electronic mail.

Ability to obtain prior authorization from medical insurance companies.

Ability to read, write and spell accurately.

Ability to maintain an effective and professional working relationship with the public and co-workers.

Ability to work as a team

Able to bend, stretch, stoop, push, pull and lift.

Able to lift 20 lbs.

Able to write reports.

Able to operate a keyboard, telephone, and other office equipment.

Able to record, prepare and communicate appropriate reports.

Ability to review documents for accuracy and completeness.

Ability to prepare records in accordance to detailed instructions.

Ability to maintain a positive work environment.

Ability to work in a fast paced environment.

Ability to maintain a flexible work schedule.

Ability to maintain client and office confidentiality.

Ability to communicate in both English and Spanish

Ability to fully comply with the enhanced infection control requirements of the clinic.

MINIMUM QUALIFICATIONS/CERTIFICATES/LICENSES/REGISTRATIONS REQUIRED: High School or GED.  Must have a minimum of 1 year work experience scheduling appointments; obtain prior authorization, registration or customer service answering telephone, providing information to patients in a healthcare setting or social service agency with knowledge of medical terminology.  This position requires an initial N95 mask fit testing and annual test fitting thereafter unless there is a significant change during the year that requires retesting prior to the annual fit testing.

Must be bilingual English/Spanish

SPECIAL INSTRUCTIONS: Due to the nature of SC Services, it may be necessary for employees to work extended hours or other variations of the usual shift to ensure adequate care to patients and to maintain service to the community.  Employee may be asked to provide coverage at other Su Clínica location, as needed.