Referral Clerk Department: Referral Center Reports To: Director of Utilization Management (UM) and Referrals FLSA Status: Non-Exempt Wage Range that the Company Expects to Pay: $20.00 - $24.31 per hour SUMMARY Under the direct supervision of the Director of UM and Referrals, the Referral Clerk is responsible for processing specialty referral orders by obtaining insurance authorization, attaching clinical documents, and submitting to specialty offices. The Referral Clerk communicates with patient... more details
Job Title: Referral Clerk
Department: Referral Center
Reports To: Director of Utilization Management (UM) and Referrals
FLSA Status: Non-Exempt
Wage Range that the Company Expects to Pay: $20.00 - $24.31 per hour
SUMMARY
Under the direct supervision of the Director of UM and Referrals, the Referral Clerk is responsible for processing specialty referral orders by obtaining insurance authorization, attaching clinical documents, and submitting to specialty offices. The Referral Clerk communicates with patients about referral details and documents in the electronic health record. The Referral Clerk obtains specialist consultation notes and closes referrals.
It is the primary purpose of CHCCC to provide the highest quality of total care possible to the patient population it serves. Such a level of quality depends ultimately on the staff's desire and ability to work together, individually, and as a team. The employee is expected to be professional, punctual, maintain regular attendance, cooperative, motivated, and organized at all times.
ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Additional duties may be assigned with or without prior notice.
Selects referrals from assigned site bucket, reviews referral order, and chart documents for appropriateness and completeness.
Contacts patient to confirm referral and advises patient of referral detail.
Obtains insurance authorization for referral and uploads into the electronic health record.
Collates electronic documents relevant to referral order (chart notes, diagnostic studies, authorization) and submits to specialist.
Documents actions in electronic health record.
Selects follow up from assigned site bucket, reviews referral documentation, and looks for associated consultation notes in electronic health record.
Contacts patient to confirm specialty appointment was made, kept, and notes date in electronic health record.
Contacts specialty office to request consultation report, if indicated.
Answers incoming telephone calls from patients or offices and addresses needs of the caller.
Reviews and responds to patient cases as assigned.
Completes chart processing and RAF requests as assigned from the Utilization Management bucket.
Requests consultation notes and/or prescriptions for 340B claims as assigned.
Demonstrates professionalism and provides quality customer service using AIDET Standards.
Ability to work with high volume of patients, internal/external customers, and deal with frequent changes, delay or unexpected events.
Demonstrates adherence to and observes all safety policies and procedures, inclusive of infection control rules and regulations.
Demonstrates the knowledge and skills necessary to provide care appropriate to the age of the patients served (infants, pediatrics, adolescents, adults or geriatrics).
Demonstrates knowledge of domestic violence, child and dependent abuse protocols.
Demonstrates cultural sensitivity and competence with patients.
Maintains and adheres to HIPAA, employee confidentiality, and privileged communications (patient, employee, and corporation).
SUPERVISORY RESPONSIBILITIES
This job has no supervisory responsibilities.
QUALIFICATIONS
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
COMPETENCIES
To perform the job successfully, an individual should demonstrate the following characteristics: resourceful, independence, detail-oriented, professionalism, problem-solver, multi-tasker, team player, and customer service.
EDUCATION and/or EXPERIENCE
High school diploma or GED required. Graduation from an accredited school in Medical Assisting or a certified or registered medical assistant (CMA/RMA), or other relevant medical experience.
LANGUAGE SKILLS
Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to respond effectively to the most sensitive inquires or complaints. Ability to write routine reports and correspondence. Ability to speak effectively before groups of patients or employees of organization.
Bilingual - ability to read, speak, and write in English and another language is strongly preferred.
MATHEMATICAL SKILLS
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.
REASONING ABILITY
Ability to apply sound judgment in understanding to carry out instructions in written or oral form. Ability to make appropriate job decisions following standard office policies and past precedents.
COMPUTER SKILLS
Experience with word processing, spreadsheets, email, and keyboarding required. Microsoft Office and Google Suite skills required. Working knowledge of EHR required.
CERTIFICATES, LICENSES, REGISTRATIONS
Possession of current, valid, unrestricted California Driver's License (Class C) required.
OTHER REQUIREMENTS
Required to pass a criminal history background check and drug screen upon hire.
Annual health examination; annual Tuberculosis skin test clearance or chest x-ray; proof of immunity to MMR, Varicella, and Hepatitis B; proof of Tdap vaccine; during current flu season, must provide proof of influenza vaccine or a signed declination form. If declined, a flu mask is mandatory during flu season.
PHYSICAL DEMANDS
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
This job is largely sedentary. While performing the duties of this job, the employee is regularly required to use hands to finger, handle, or feel; reach with hands and arms; and talk or hear. The employee will have repetitive finger and hand motions when typing. The employee will regularly need to operate a computer, keyboard, and telephone. The employee is regularly required to sit for an extended period of time however, may be frequently required to stand and walk. The employee may need to lift and/or move up to 25 pounds of supplies. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and ability to adjust focus.
WORK ENVIRONMENT
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is frequently exposed to moving mechanical parts. The employee is occasionally exposed to risk of electrical shock. The noise level in the work environment is moderate (i.e. office setting with computers, phones, and printers). Must be able to work in a cubicle setting and work in a fast-paced environment consisting of inbound and outbound calls.
Must be willing to have a flexible work schedule that may include evenings/weekends, and travel as needed.
