Referrals and Authorizations Clerk

ROLE OVERVIEW and PURPOSE

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

Direct Patient Care

• 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 information and access such information
  only on a need-to-know basis for business purposes
• Complies with all regulations regarding corporate integrity and security obligations
• Reports all behavior and/or activity that are unethical, fraudulent, or unlawful

Pay Range: $22.00 to $29.41 per hour, depending on experience

Compensation Disclosure: The posted salary range reflects the designated pay grade for this position. While this range represents the broader classification of the role, actual compensation will be based on several factors, including but not limited to: the candidate’s overall knowledge, skills, and experience, market data and industry benchmarks, internal equity within the organization, Budgetary considerations and organizational needs. As a result, placement within the range is not guaranteed, and the full pay grade range may not be utilized.