Referral Clerk

Shenandoah Valley Medical System•Martinsburg, WV

5d•Onsite

About The Position

Shenandoah Community Health (SCH) is a Federally Qualified Health Center whose mission is to provide access to healthcare by reducing barriers to care. Our coordinated range of services includes primary care, women's health, behavioral health, oral health, HIV case management, pharmacy, lab, radiology, and a variety of support services. SCH also offers interpretation services for patients whose primary language is not English. Working at SCH is more than just a job, it is an opportunity to impact the lives of the people living in our community. Come join our team! To learn more about SCH, visit www.shencommhealth.com .

Requirements

High school education or its equivalent required.
Minimum 3 years medical office experience.
Prior referral experience.
Prior experience with insurance companies.
Proficient computer skills.
Microsoft office (Excel and Word).
Customer service skills.
Detailed oriented.
Ability to respond quickly and appropriately in urgent or emergency situations.

Nice To Haves

One year of college or vocational training in a medical office preferred.

Responsibilities

Maintains ongoing tracking and appropriate documentation on referrals to promote team awareness and ensure patient safety.
Resolves pre-certification, registration, and case-related concerns prior to a patient’s scheduled appointment.
Communicates with patients and visitors.
Works in a high-volume environment to obtain authorization, schedule, and track referrals electronically to completion.
Organizes and maintains a system for review of referrals by identifying concerns to physician/clinical staff as required and placing the referral in the designated area for review.
Determines appointment priority by evaluating patient information such as patient history, test results and pertinent reports.
Serves as the point of contact for patients and specialists for any questions or rising concerns.
Assists in problem-solving potential issues related to their referral due to language or social barriers.
Reviews the medical necessity of each referral with the ordering provider, insurance company, and patient.
Requests new referrals to be ordered when applicable.
Reviews suitability/availability and emergency bookings by communicating with the appropriate providers.
Contacts insurance companies to ensure prior approval requirements are met.
Presents necessary medical information such as, history, diagnosis and prognosis to insurance companies if deemed necessary to prove medical necessity of services.
Receives/requests referral information, patient demographics and other clinical data.
Accurately completes insurance/testing forms.
Records and/or enters a variety of information including consultation, dates, locations and types of examinations/procedures/imaging.
Processes written or verbal instructions from provider, including initiating requisitions, requesting appointments for diagnostic imaging, consultations, completing forms, and requesting additional documentation.
Identifies and utilizes community resources; establishes relationships with servicing providers and personnel.
Accurately enters notes into EMR System regarding letters or correspondence from insurance companies regarding insurance authorization or other notifications.
Scans documents into the appropriate patient’s chart in EMR system.
Accurately fills out consultant request and sends appropriate medical records to the specialist/insurance provider in a timely manner.
Electronically submits all clinical documents to medical records to file in the electronic health record.
Routes documents for physician review as required.