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Referral Clerk

Job Details


Position Summary

The Referral Clerk is responsible for verifying eligibility, checking benefits, documenting physician direct referrals and preauthorizations of certain services, via phone, fax or e-mail. This position will also be responsible for scheduling appointments with specialist and other community resources as instructed by primary care provider.

Flexible, may require some evening and weekends

Primary Duties and Responsibilities
Process HMO, PPP, EAPC, CHDP and other specialty referrals
a. Completion of authorization request form
b. Fax or e-mail referral request to respective IPA/Health Plan, County and etc. along with the required pertinent information to support the request.
c. Notify patients (if necessary) regarding authorization decision; approved or denied
d. Schedule appointments with Specialists and notify patients
e. Follow up status on referrals for completion
-No show- reschedule
-Follow-up visit(s) either with Specialist or PCP
-Consultation Reports
Responsible for filing completed referral forms in the medical charts
Maintain referral logs per financial class, i.e., HMO, PPP, etc.
Weekly report to QM on specialty utilization
Comply with the IPA, Health Plan and/or Programs UM Protocols
Ensures HIPAA Compliance at all times
Work closely with Clinic Providers and maintain communication on referral status
Review and maintain referral log
Act as liaison between clinic and managed care department
Other duties as assigned by supervisor


Minimum Requirements
Microsoft Office/Word/Excel/Outlook
Excellent Communication Skills
Excellent Customer Service Skills
Bi-lingual Spanish/English preferred
Ability to work as a team player and work independently
Reliable transportation
Must be able to travel from facility to facility
This position requires 10 % travel outside the local area.

Required Education/Experience and/or Licensure/Certification
Medical Assistant Certificate or Certified Medical Assistant (Preferred)
Billing Certificate or Understanding of Medical concept
High school diploma or GED equivalent
Minimum 0.5 years of positional experience
Commitment to goals and philosophy of Northeast Community Clinic
Current CPR and/or BLS Certification
Valid State Identification

Physical Requirements and Working Conditions
OSHA Category 2 Involves no regular exposure to blood, body fluids, or tissues, but may require unplanned tasks that involve exposure to blood, body fluids, or tissues.
The work is majority of the time sedentary in nature.
The employee is regularly required to communicate, frequently required to use repetitive motions, move, remain stationary, regularly push, pull and lift up to 20 pounds and occasionally push, pull and lift up to 40 pounds.
Must possess mobility to work in a standard office/clinic setting (in some cases both settings) and to use standard office/clinic equipment, including a computer, stamina to maintain attention to detail despite interruptions, read printed materials and use a computer, and communicate in person and over the telephone.