Referrals and Authorizations Clerk

The primary responsibility of the Referrals and Authorizations Clerk is to coordinate all referrals and follow-up care for 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.

Work hours:

Mon-Fri, 8am-5pm

• 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

EDUCATION/EXPERIENCE

• High School Diploma/GED required
• 1 year patient services/referrals experience in medical office environment preferred
• Bilingual (English/Spanish) or (English/Arabic) highly 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

PHYSICAL REQUIREMENTS

• Ability to lift/carry 20lbs/weight
• Ability to sit or stand for long periods of time

COMPLIANCE (Safety & HIPAA)

• Follows all safety procedures as outlined in Neighborhood Healthcare’s Illness and Injury
  Prevention Plan (IIPP) and report any injuries and/or unsafe conditions immediately
• Maintains current knowledge of policies and procedures as they relate to safe work practices
• Uses appropriate body mechanics to ensure an injury free environment
• Familiarity with location of nearest fire extinguisher and emergency exits
• Follows all infection control procedures including blood-borne pathogen protocols
• Maintains privacy of all patients, employee and volunteer…