Referrals & Medical Records Clerk

JOB RESPONSIBILITIES

Administrative Duties:

Route clients/patients to the appropriate areas within the agency.

Answer phones, check and return voice messages in a timely basis.

Update patient demographics in agency data system as appropriate.

Referrals/Authorization:

Verify patient insurance carrier/coverage to ensure proper processing of referrals.

Respond to all correspondence and task (via letter, email, faxes) in a timely manner.

Record and maintain patient health records in agency’s database and other data systems.

Process referrals for patient specialist visits including in house specialist and outside providers (via insurance portals, phone calls, etc.)

Coordinate appointments for patients with specialists.

Ensure updates are made in EHR regarding appointments made for specialist, patient attendance and/or comments, etc.

Process additional information requested by insurance companies for authorizations (medical records, documentation from providers, etc.).

Assist in authorization denials and appeals on behalf of the patient and document outcomes in record system.

Identify alternative solutions, as determined necessary by providers, for denied authorizations.

Ensure external 3rd party documentation (i.e. labs, consultation reports, etc.) is collected and entered in the patient’s electronic health records (EHR).

Ensure proper and timely closing of tasks as it relates to referrals and open orders via EHR.

Medical Records:

Receive and document medical records requests from outside agencies (Social Security Administration, legal offices, outside providers or patient request)

Prepare invoices for payments of medical records request.

Prepare medical records as requested by printing from EHR and prepping for faxing or mailing.

Ensure documentation for new patients is collected and recorded in patient’s electronic health records (EHR).

Ensure patient documentation is fully completed and recorded in agency’s database.

Ensure appropriate assignment to the provider upon receiving records and closure of task by the provider, once the records are obtained.

Quality Assurance/Compliance:

Assist in ensuring that the medical office (front desk and waiting area) is kept clean and tidy at all times.

Ensure online training is current as required (My LearningPointe and other trainings).

Ensure that medical operations fully comply with agency and HIPAA requirements.

Safety:

Ensure proper hand washing according to the Centers for Disease Control and Prevention guidelines.

Understands and appropriately acts upon assigned role in Emergency Code System.

Understands and performs assigned role in agency’s Continuity of Operations Plan (COOP).

Culture of Service: 3 C’s

Compassion

Greet internal or external customers (i.e. patient, client, staff, vendor) with courtesy, making eye contact, responding with a proper tone, and nonverbal language.

Listen to the internal or external customer (i.e. patient, client, staff, vendor) attentively, reassuring, and understanding of the request and providing appropriate options or resolutions.

Competency

Provide services required by following established protocols and when needed, procure additional help to answer questions to ensure appropriate services are delivered

Commitment

Take initiative and anticipate internal or external customer needs by engaging them in the process and following up as needed

Prioritize internal or external customer (i.e. patient, client, staff, vendor) requests to ensure the prompt and effective response is provided

Safety

Ensure proper handwashing according to the Centers for Disease Control and Prevention guidelines.

Understands and appropriately acts upon the assigned role in Emergency Code System.

Understands and performs assigned roles in the organization’s Continuity of Operations Plan (COOP).

Contact Responsibility

The responsibility for external contacts is constant and critical.

Physical Requirements

This work requires the following physical and sensory activities: constant sitting, hearing/ visual acuity, talking in person, and on the phone. Frequent, walking, standing, sitting, and bending. Work is performed in-office setting.

Other

Participates in health center developmental activities as requested.

Other duties as assigned.

Job Knowledge and Skills:

Bilingual (English Spanish) is preferred. Computer knowledge should include Microsoft Outlook, Word, and Excel. Excellent problem solving, communication, organizational and teamwork skills are required. The ability to work with a multicultural and diverse population is required.

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