Referral Clerk

Planned Systems International, Inc.•Portsmouth, VA

4d•Onsite

About The Position

QuarterLine (QL), a Planned Systems International (PSI) company, is seeking a dedicated and compassionate 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.

Requirements

High School Degree or GED.
The contract worker performing under this contract must be a U.S. Citizen.
Basic Life Support (BLS) from the American Heart Association or the American Red Cross. Certification cards must display the American Heart Association or the American Red Cross. Web-based (on-line) classes are not acceptable by the Government.
Must pass TB Test.
Subject to a background/security investigation.
Willingness to comply with DHA vaccination requirements.
Pre-employment drug screening.
Contract workers shall maintain good personal hygiene and present a well-groomed and professional appearance IAW the policy at the place of performance.

Responsibilities

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.
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.