Revised: 10/04/2017 I.
The Referral Clerk will schedule appointments with physician offices, hospitals and other facilities for diagnostic procedures and specialist referrals. Responsible for obtaining prior authorizations from insurance companies on diagnostic procedures ordered. Collaborate professionally with all clinical staff such as physicians, nursing, radiology techs and patients in coordinating referral appointments and procedures.
Designated as contact person for all referrals in the Urgent Care department across all Urgent Care locations. II. Position Relationships: A.
Responsible to: RN Charge & Divisional Director of Urgent Care B. Workers Supervised: None C. Interrelationships: Works closely with patients, their families, physicians and other members of the Health Care Team, which may entail other community agencies.
III. Responsibilities and Authorities: A. Performs other duties as assigned by the department's management staff.
B. As patient care and/or Hospital need dictates, both the assigned shift and work station may be changed by the department. C.
Participates in and promotes the “I CARE” service philosophy of Integrity, Customer Centered, Accountability, Respect and Excellence. D. Performs essential job functions with or without reasonable accommodations.
E. Familiarize themselves with all the different types of insurance, Medicaid, and Medicare requirements for diagnostic procedures and referrals. F.
Obtain prior authorizations and follow ups on pending referrals. G. Identify patient payer source and educating the patient on self-pay requirements.
H. Attempt to refer within the organization and outside on as needed basis. I.
Schedule appointments within a timely manner with scheduling and other offices. J. Following up with patient on appointment details and any restrictions/instructions in regards to scheduled appointment.
K. Documenting all the appropriate documentation in Electronic Medical Record (EMR) on status of referrals and appointment details. L.
Designated as contact person for all questions and concerns regarding all Urgent Care referrals. M. Maintain confidentiality and stay in compliance with HIPAA regulations.
N. Performs essential job functions with or without reasonable accommodations. O.
Work closely with providers, nursing and radiology techs and patients to coordinate referrals and procedures. IV. Performance Factors Used to Evaluate Employee: A.
Works closely with providers and clinical staff in obtaining accurate information for diagnostic procedures and referral appointments. B. Obtains and verifies current insurance information for patient prior to initiating referrals.
C. Performs accurate, thorough and timely data entry in electronic medical record (EMR) system regarding procedures and referrals. D.
Demonstrates good verbal and written communication skills, documents and reports clearly and concisely. E. Uses friendly, courteous and professional communication skills by phone and in person at all times.
F. Records and relay messages to patient, providers and clinical staff in regards to procedures and referrals promptly and accurately. G.
Knowledgeable with patient privacy laws (HIPPA) and maintain patient confidentiality. V.
A.
High School diploma or equivalent. C. Job Knowledge: Strong communication skills.
Ability to maintain a calm demeanor under stressful working conditions. Ability to conduct professionalism and courtesy in person and by phone at all times. VI.
Unusual Physical Demands and Working Conditions: A. Must be able to work under stressful conditions and handle heavy workload. B.
Must be able to perform/withstand extended periods of sitting and being on the phone.