Referral Clerk

AAI•Twentynine Palms, CA

About The Position

AAI is focused on delivering outstanding services to the federal government. We have extensive experience in the fields of cybersecurity, development, IT infrastructure, supply chain management, and other professional services such as system design and continuous improvement. AAI is a VA CVE-certified Service-Disabled Veteran-Owned Small Business (SDVOSB), SBA-certified Economically Disadvantaged Woman-Owned Small Business (EDWOSB), and a Woman-Owned Small Business (WOSB) with offices in Hampton Roads, Virginia, Montgomery, AL, Washington, DC, and Atlanta. Fully qualified candidates are welcome to apply directly on our website at: https://aaionline.us/ AAI is actively looking for a referral Clerk. This position provides clerical/administrative support in the Referral Management Center for customer service, referral tracking, referral appointing, and reporting activities. This position will support the daily functions of specialty care referral appointments, referral review and coordination, beneficiary counseling, and referral tracking at the MTF.

Requirements

High school diploma or General Educational Development (GED) equivalency.
At least 6 months of experience in a medical office setting.
Possess and maintain current certification in American Heart Association Basic Life Support (BLS) for Healthcare Providers.
A fully qualified typist with a minimum of 50 WPM is required.

Nice To Haves

Completion of an Administrative Assistant program is desired.

Responsibilities

Demonstrate general medical ethics, telephone etiquette, and excellent communication and customer service skills.
Possess general office administrative and clerical skills to perform receptionist duties and answer telephones.
Ability to communicate effectively, both orally and in writing.
Greets patients/visitors at a front desk, referral center, or office setting.
Answers the main office phone line(s).
Directs telephone calls to the appropriate section for assistance, handles independently, or takes messages as required.
Reviews all incoming CLR referrals for administrative accuracy, completeness, and legibility, and posting of consultation reports for patients referred both to and from providers
Determines patient eligibility for services, arranges and schedules medical appointments for referred care, and contacts the physician’s office if an incoming report does not meet the CLR standards.
Provides general instructions to patients and ensures patients have the necessary documentation for referred health care services.
Obtains updates and files medical records as needed.
Organizes and researches patient records, extracts needed information, and reviews records for referral results within established guidelines.
Request medical records and ensure the arrival of medical records prior to appointment(s).
Initiates and locates patient medical records as needed.
The contractor shall establish and maintain suspense files for referrals deferred to the network and compile and maintain data for reporting and tracking purposes.
Obtains documentation as requested by healthcare providers (test results, or documentation not yet filed in records), and provides CLR receipts validation and shall cross-check referral authorizations against claims adjudicated.
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.
Notifies MTF providers when a CLR is posted and monitors timelines of incoming CLRs.
Utilizes the referral tracking data collection tool.
Calculates metrics and compiles monthly statistic reports, which include the number of actions processed each month.
Contact the Provider and network provider offices to determine if the patient was seen and if so, acquire referral results.
The contractor shall properly close referrals in MHS Genesis and the Referral Management System/Referral Management System Tracking Reports appropriately and shall forward an informational advisement of the referral status to the initiating MTF provider or PCM. Contacts shall be documented per MTF instruction.
Properly document patient responses in MHS Genesis and the Referral Management System/Referral Management System Tracking Reports and HAIMS.
The contractor shall provide notification to the referring Provider of patient requests to cancel referrals.