Referral Clerk

Referral Clerk

Shenandoah Community Health (SCH) is a Federally Qualified Health Center whose mission is to provide access to healthcare by reducing barriers to care. Our coordinated range of services includes primary care, women's health, behavioral health, oral health, HIV case management, pharmacy, lab, radiology, and a variety of support services. SCH also offers interpretation services for patients whose primary language is not English. Working at SCH is more than just a job, it is an opportunity to impact the lives of the people living in our community. Come join our team!

Job Summary:

Under the direct supervision of the Health Information Manager, the Referral Clerk is primarily responsible for maintaining ongoing tracking and appropriate documentation on referrals to promote team awareness and ensure patient safety. Resolves pre-certification, registration, and case-related concerns prior to a patient's scheduled appointment. This position requires the Referral Clerk to communicate with patients and visitors. The Referral Clerk must be able to multi-task and be proficient with computers. The Referral Clerk must be able to work in a high-volume environment to obtain authorization, schedule, and track referrals electronically to completion. The Referral Clerk will use multiple systems such as Microsoft Office, Cloud based phone systems, Citrix, Insurance websites, Web based referral tracking system, NextGen, Epic Carelink, and Zoom.

Role & Responsibilities:

• Organizes and maintains a system for review of referrals by identifying concerns to physician/clinical staff as required and placing the referral in the designated area for review.
• Determines appointment priority by evaluating patient information such as patient history, test results and pertinent reports.
• Point of contact for patients and specialists for any questions or rising concerns. Assist in problem solving potential issues related to their referral due to language or social barriers. If unable to help, assist in finding the right point of contact to further help.
• Reviews the medical necessity of each referral with the ordering provider, insurance company, and patient. Requests new referrals to be ordered when applicable.
• Reviewing suitability/availability and emergency bookings by communicating with the appropriate providers.
• Contacts insurance companies to ensure prior approval requirements are met. Presents necessary medical information such as, history, diagnosis and prognosis to insurance companies if deemed necessary to prove medical necessity of services.
• Receiving/requesting referral information, patient demographics and other clinical data.
• Accurately completes insurance/testing forms.
• Recording and/or entering a variety of information including consultation, dates, locations and types of examinations/procedures/imaging.
• Processes written or verbal instructions from provider, including initiating requisitions, requesting appointments for diagnostic imaging, consultations, completing forms, and requesting additional documentation.
• Identifies and utilizes community resources; establishes relationships with servicing providers and personnel.
• Accurately enter notes into EMR System regarding letters or correspondence from insurance companies regarding insurance authorization or other notifications. These documents should also be scanned into the appropriate patient's chart in EMR system.
• Accurately fills out consultant request and sends appropriate medical records to the specialist/insurance provider in a timely manner.
• Electronically submitting all clinical documents to medical records to file in the electronic health record.
• Routing documents for physician review as required.

Essential Skills and Education Requirements:

High school education or its equivalent required. One year of college or vocational training in a medical office preferred. Must have minimum 3 years medical office experience.

Have prior referral experience, prior experience with insurance companies, proficient computer skills, Microsoft office (Excel and Word), customer service skills and be detailed oriented.

Ability to respond quickly and appropriately in urgent or emergency situations.