Referral Clerk I

About the role

The Referral Clerk I organizes, schedules, coordinates, and tracks patient referrals to specialists, healthcare agencies and outpatient facilities. They work closely with provider staff, clinical support staff, patients, and insurance carriers to ensure timely processing of clinical referrals.

Job duties and responsibilities

• Coverage of patient referrals to specialist providers and health care agencies according to Policy and Procedure.
• Maintain ongoing tracking and appropriate documentation on referrals to promote team awareness and ensure patient safety.
• Ensure complete and accurate patient demographic and current insurance information.
• Receive request for clinical records and ensure all requested records are sent.
• Assemble information concerning patients clinical background and referral needs; provide appropriate clinical information to specialist.
• Contact insurance companies to ensure prior approval requirements are met.
• Present necessary medical information such as history, diagnosis, and prognosis.
• Review details and expectations about the referral with patients.
• Communicate clearly with the patient who the patient is being referred to and why, what their insurance will cover and whether there are co-pays or other charges, what documentation needs to be done prior to the visit, and what information to bring to visit.
• Inform uninsured and underinsured patients of all payment options including community assistance program applications.
• Communicates to patients the importance of keeping referral appointments and the inherent risks of lack of follow-up.
• Engages patient in the referral decision making process to improve adherence with referral and follow-up.
• Aid patients with logistical support and problem-solving potential issues related to the health care system, financial or social barriers (e.g., transportation services, prescription assistance, or request for interpreters).
• Be the system navigator and point of contact for patients and families, with patients and families having direct access for asking questions and raising concerns.
• May assume advocate role on the patients behalf with the carrier to ensure approval of the necessary supplies/services for the patient in a timely fashion.
• Identify and utilize cultural and community resources.
• Establish and maintain relationships with identified service providers.
• Ensure that referrals are addressed in a timely manner.
• Maintain documentation of sent referrals and status of scheduling referrals, for tracking.
• Help address barriers that delay patient follow-through with referred specialty visits.
• Remind patients of scheduled appointments via phone and/or mail.
• Track closure of referrals; maintain documentation of status for received medical records, including consult notes, following referred specialty visits.
• Follow-up with specialists about information delays.
• Follow-up with patients who miss referral appointments and encourage them to reschedule.
• Reemphasize the risks of missing referral appointments.
• Ensure up-to-date documentation of all patient referrals, communication with patients about the risks of not attending referral appointments, reminders, and efforts to follow-up with patients who miss referral appointments in the patients medical record.
• Participate in chart audits to monitor referral tracking.
• Greet patients, caregivers, and staff in a timely and pleasant manner.
• Project a congenial and sensitive attitude toward patients, caregivers, and staff.
• Exhibit a willingness to resolve roblems and inefficiencies.
• Provide consistent, timely and friendly service to both external and internal customers.
• Actively support departmental and organizational strategic plans.
• Actively support departmental and organizational quality assurance and performance improvement initiatives.
• Perform other duties as assigned.

Qualifications

• High school diploma or equivalent.
• Knowledge and experience in outpatient clinic setting and insurance prior authorization processes preferred; experience and/or training in medical terminology preferred.
• Communication Ability: Ability to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals. Must have interpersonal skills. Ability to write routine reports and correspondences. Ability to speak effectively with provider and clinical support staff, insurance carriers, and patients.
• Math Ability: Ability to add and subtract two-digit numbers and to multiply and divide with 10s and 100s. Ability to perform these operations using units of American money and weight measurement, volume, and distance.
• Reasoning Ability: Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram or schedule form. Ability to work reliably and with professionalism in a high-volume, high-demand medical environment.
• Computer Skills: Proficiency in Microsoft Word, Microsoft Excel, and e-mail. Prefer skills in using referral EHR/ eCW software and RadMD applications.
• Professional Skills: High level of confidentiality required. Ability to work independently and within a team.

Benefits

• Medical, Vision and Dental Health Insurance
• Accidental Insurance
• Critical Illness Insurance
• Long Term Benefits
• Short Term Benefits
• Free Life Insurance
• 401K Plan