In collaboration with the Medical Assistant Team the Referral Clerk assures the timely submission of referrals for outside medial services including the distribution of appropriate background medical records needed to assure appropriately delivery of services by the specialty provider as well as submission of necessary information to complete any necessary prior authorizations for the requested service. In addition, the Referral Clerk will monitor receipt of reports of the specialty service upon completion and assure the information is appropriately forwarded and filed in the medical record. This position reports to the Medical Assistant Supervisor.
Essential Duties and Responsibilities
- Works independently and collaboratively as part of a team to ensure the timely processing of patient referrals in accordance with level of priority based on provider's notes in patient's medical record. This includes making linkages between patients and service providers in an acceptable timeframe to ensure continuity of care.
- In a detail-oriented manner, assists providers in filling out proper documentation for referrals/authorization as required by service provider(s).
- Utilizing diplomacy and tact, assists patients in troubleshooting connections with external service providers to remove barriers to services, whether real or virtual. Handles all interactions with patients in a friendly customer-service and solutions-oriented manner.
- Responsible for obtaining timely authorization from patients' insurance carrier as needed.
- Follows-up with patients and/or outside medical facilities to determine if patient kept their scheduled appointment.
- Works with providers to address failed appointments in the interest of achieving best possible outcomes for patients.
- Works collaboratively with other medical facilities, providers and community agencies to maintain up-to-date resource guides of facilities where patients are referred.
- Runs reports according to policies and procedures to follow up on open referrals and diagnostics until closing the loop, electronically filing and documenting steps in the process.
- Enter pertinent medical information into the order management section in EHR.
- Attends staff and medical meetings, as required.
- Performs other related duties in accordance with agency growth and changes.
Skills / Requirements
- High School Diploma or G.E.D.
- A minimum of two (2) year experience previous Medical Referral experience AND
- A minimum of one (1) year experience working in a clinical setting, skills in office duties, customer service, insurance and billing, and patient care.
- Certified Nursing Assistant and/or Certified Medical Assistant, preferred.
- Bilingual a plus.
- Valid Arizona Driver’s license, proof of current insurance and willingness to use personal vehicle.
- Clean Motor Vehicle Record - no more than 2 moving violations or a license suspension in past 3 years.
- General medical ethics, telephone etiquette, and excellent communication and customer service skills.
- Knowledge of principles and processes for providing excellent customer service.
- Ability to follow written and oral instructions, and to communicate effectively both orally and in writing.
- Ability to establish and maintain effective working relationships with staff, providers, members, funding sources and other agencies.
- Ability to maintain confidentiality and comply with HIPAA standards.
- Extensive knowledge of community resources.
- Familiarity with various ethnic and cultural groups.
- Intermediate to advanced computer skills using MS Office products, Word, Excel, Access, etc., importing/exporting data to/from applications.