Referral Specialist

I. POSITION SUMMARY:

Under the direction of the Clinic Manager, the Referrals Clerk is responsible for all duties related to submitting pre-authorizations and pre-certifications. The Referrals Clerk is responsible for promoting positive communications with all departments within the clinic and affiliated agencies including but not limited to physician’s offices and insurance companies.

II. ESSENTIAL FUNCTIONS:

Referrals Clerk Functions:

• Makes patient care referrals to outside agencies according to policies, procedures and responsibilities.
• Documents all referrals and forwards referral documents to appropriate personnel / department.
• Follows up the referrals in a timely manner to assure that appointments are made for appropriate care or testing.
• Answers patient inquiries and takes messages for follow up.
• Assists providers in completing all medical documentation needed to provide referral services following the specific procedure provided by Nurse Supervisor as to what needs to be sent to specific entities.
• Participates in staff meetings and other meetings as instructed.
• Maintains confidentiality within the workplace and within the community.
• Handles protected health information in a manner consistent with the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
• Adheres to the Mission and Values
• Performs other duties as required and assigned.

I. EDUCATION/EXPERIENCE REQUIREMENTS:

High school graduate or equivalent, Medical Assistant – preferred. Basic typing skills required with ability to use office equipment required; basic course in medical terminology preferred.

Bilingual in English and Spanish required (must be able to communicate effectively with patients, families, and staff in both languages

II. PHYSICAL DEMANDS 

a. Physical Activity - Exerting up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently, and/or a negligible amount of force constantly to move objects. Physical requirements are in excess of sedentary work. Even though the weight lifted may be only a negligible amount, a job should be rated Light Work: (1) when it requires walking or standing to a significant degree: or (2) when it requires sitting most of the time but entails push and/or pulling of arm or leg controls; and/or (3) when the job requires working at a production rate pace entailing the constant pushing and/or pulling of materials even though the weight of the material is negligible. 

b. Working Hazards or Risks – potential for musculoskeletal injuries related to moving and working with files and office equipment.

c. OSHA Blood Borne Risk Category III.