Referral Clerk

Referral Clerk

Integrated Management Strategies (IMS) is an award-winning, fast-growing woman-owned small business in the Washington DC area, specializing in healthcare, technology, and management consulting. We are seeking an experienced Referral Clerk to join our healthcare consulting practice. The role is on-site full time in Portsmouth, VA.

We are seeking a qualified Referral Clerk to support a government healthcare contract at Naval Medical Center Portsmouth, Virginia, within a Department of Defense (DoD) medical treatment facility. The selected candidate will manage patient referral processes, including coordinating specialty care appointments, processing consults, tracking authorizations, and maintaining accurate records in accordance with contract requirements and clinical workflows. This role requires strict adherence to HIPAA, TRICARE, and DoD regulatory standards, ensuring timely and accurate handling of referrals to support continuity of care.

The ideal candidate will demonstrate strong organizational and communication skills while collaborating with providers, case managers, and external networks in a fast-paced environment. This position requires a dependable professional who can meet government credentialing, security, and onboarding requirements while contributing to mission readiness and high-quality patient care for service members and eligible patient populations.

What you'll do:

• Reviews referrals for administrative completeness and researches covered benefits prior to processing.
• Determines patient eligibility for services and arranges and schedules medical appointments for referred care.
• Provides general instructions to patients and MTF personnel regarding the referral procedures.
• Ensures referral results are returned to the referring provider and to the medical record within required timelines. Assists with follow up, written or verbal, as necessary.
• Utilizes the referral tracking data collection tool. Calculates metrics, and compiles monthly reports.
• Utilize the MHS GENESIS system to retrieve external medical documentation, termed Clear and Legible Reports (CLRs), and upload the results into the patient's chart.
• Utilize telecommunications technology to collect external documentation for patients within NMC Portsmouth by contacting outside clinical practices to retrieve patient and service documentation.
• The expected daily target for contracted personnel is at least 70 CLRs on a standard workday and 50 CLRs on days focused on collecting external documentation.
• As needed, communicate with providers regarding CLRs if they are incorrect or need additional context; this communication is likely to come through MHS GENESIS.
• Review referral notes, including but not limited to; consultation, operative, and discharge summaries requested when a TRICARE Beneficiary is referred to external providers for care. Return these external documentations to the patient chart.
• Chase external notes from network providers for patients to upload into the patient chart for clear reporting of patient encounters through various telecommunication methods including phone, fax, and secure mail.
• Respond to provider queries regarding external provider notes and documentation.
• Ensure referral results are returned to the referring provider and to the medical record within required timelines. Assist with follow up, written or verbal, as necessary.
• Utilize the referral tracking data collection tool within MHS GENESIS and discern reporting system to measure amount of outstanding CLRs.

Qualifications:

• Minimum of one (1) year of experience
• US Citizen
• Basic Life Support (BLS)
• High School Degree or GED
• Must pass TB Test
• Subject to a background/security investigation
• Willingness to comply with DHA vaccination requirements.
• Pre-employment drug screening
• Shall maintain good personal hygiene and present a well-groomed and professional appearance IAW the policy at the place of performance.

Integrated Management Strategies is an equal opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, gender identity, national origin, disability, pregnancy, status as a protected veteran, or any other protected characteristic as outlined by federal, state, or local laws. If you are an individual with a disability and would like to request a reasonable accommodation for the employment process, please email your request to View email address on click.appcast.io

E-Verify® is a registered trademark of the U.S. Department of Homeland Security. This business uses E-Verify in its hiring practices to achieve a lawful workforce.

The salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary rate for this position will be determined by a number of factors, including, scope, complexity, and location of the role; the skills, education, training, credentials, and experience of the candidate, and other conditions of employment.