Referrals Clerk

La Clinica Del Valle•Medford, OR

17h•Onsite

About The Position

The Referral Clerk will screen and support patients in connecting with specialty offices based on medical provider referrals. This role is responsible for closed-loop processing of specialty referrals, including communication with the patient, insurance company, and specialty referral provider. The clerk will monitor referral work queues, prioritize based on urgency, request prior authorization, submit referral requisitions, and follow up on pending requests. They will also inform the ordering provider if a patient declines, cancels, or fails to show for an appointment. The position requires maintaining relationships with specialty referral providers, navigating internal and external referral systems, and acting as a primary point of contact for patients and families. The clerk may advocate on behalf of the patient with insurers to ensure timely approval of necessary services. Additionally, they will ensure patient care documentation in EPIC, follow workflows for patient engagement standards, and respond courteously to the Referrals-workgroup line.

Requirements

High school diploma or general education degree (GED)
Excellent interpersonal communication and problem-solving skills
Skills to intervene and promote reconciliation, compromise and positive outcomes in difficult interactions

Nice To Haves

Medical terminology
One year of work experience in medical office setting
Skilled at using electronic health records as applicable to area of work (EPIC)
Bilingual in English and Spanish

Responsibilities

Responsible for closed loop-processing of specialty referrals including: communication with patient, insurance company and specialty referral provider as indicated.
Monitor referrals work queues daily for outgoing referrals and prioritize based on the referral priority set by the ordering provider.
As required, request prior authorization, following the patient’s specific insurance plan’s requirement.
Submit referral requisition and supporting documentation to the specialty provider’s office.
Follow up on referral requests that are pending a specialty consultation report
Inform ordering provider if patient declines, cancels, or fails to show to an appointment.
Maintains relationship and supports communication standards with specialty referral providers.
Navigates internal, and external referral systems and is primary point of contact for patients and families. May assume advocate role on the patient’s behalf with the insurer to ensure approval of the necessary services for the patient in a timely fashion.
Ensures the documentation of patient care in EPIC and is responsible for following workflows that result in capturing activities to meet patient engagement standards as outlined in the APCM program.
Responds to the Referrals-workgroup line in a courteous and professional manner following La Clinica customer service and telephone standards.
Develops and maintains professional, support-oriented working relationships with patients, employees, team members, and community partners.
Demonstrates continuous improvement in achieving “developing” and “fully competent” levels of La Clinica’s Behavioral Standards.
Follow La Clinica’s SERVE standards: Service, Empathy, Relationships, Value, and Excellence.