Referral Clerk

Referral clerk is responsible for preparation and processing referrals according to health plan benefits and appropriate contracted provider. The referral coordinator identifies health plan and CMS documents needed to assist next level of review. The position would also involve going online or calling for benefits, Health Plan policies or criteria for referrals received via EHR or via fax. Essential duties include providing excellent customer service/patient services via phone. The position must exemplify the core values and mission Peñate Medical Centers the core values and mission of the organization, always exercising utmost discretion, diplomacy and tact in patient/staff interactions. Reports directly to Referral Manager.

DUTIES AND RESPONSIBILITIES:

• Maintain ongoing tracking and appropriate documentation on referrals
• Ensure complete and accurate patient demographic and current insurance information
• Assist patient with scheduling appointments
• Review details and expectations about referrals with patients
• Establish and maintain relationships with identified service providers
• Responsible for scheduling consultations, diagnostic testing and surgical procedures
• Responsible to schedule and notify patients of scheduled appointment via mail and phone
• Ensure that referrals are addressed in a timely manner
• Responsible for verifying eligibility and benefits through insurance companies including obtaining prior authorization
• Protects patient confidentiality, making sure protected health information is secured by not leaving PHI in plain sight and logging off the computer before leaving it unattended
• Answer phone calls referral related and offer assistance to ensure 1st call resolution
• Works as a liaison in between medical center and patient and sends tasks accordingly
• Responsible to notify referral manager of any issues or concerns from patient and/or provider
• Follow up on patient referral inquires not immediately resolved
• Assists as needed or directed with other department or business needs

KEY COMPETENCIES:

Planning and organizing, communication skills, attention to detail, adaptability, customer service orientation, problem solving, decision-making, confidentiality, integrity, stress tolerance.

EDUCATION AND EXPERIENCE:

• High school diploma or graduation equivalency degree (GED)

• 2-5 years of relevant experience with managed care referral preferred
• Bilingual English/Spanish/Creole strongly preferred
• Excellent time management and organizational skills
• Knowledge of applicable regulations and state and federal laws
• Computer skills including knowledge of relevant software
• Ability to multitask in a fast pace environment

The person should be multifunctional and have the ability to multi-task; the person should have strong communication skills; must have strong organizational skills; must have strong customer service and conflict resolution skills; must have strong troubleshooting skills; must have knowledge of insurance and medical terminology. Must possess strong computer skills.

** Must be Bilingual (English and Spanish)

Job Type: Full-time

Pay: $14.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Medical Specialty:

• Primary Care

Schedule:

• 8 hour shift

Education:

• High school or equivalent (Preferred)

Language:

• Spanish (Preferred)

Work Location: In person

Salary : $14