The Referrals & Medical Records Clerk is primarily responsible for administrative duties and support within the medical department primarily related to referrals, authorizations, and medical records.
Essential Job Responsibilities
Administrative Duties:
Routes clients/patients to the appropriate areas within the agency.
Answers phones, checks, and returns voice messages on a timely basis.
Updates patient demographic in the agency's data systems (EHR, Case watch, Provide) as appropriate.
Referrals/Authorization:
Verifies patient insurance carrier/coverage to ensure proper processing of referrals.
Responds to all correspondences and tasks (via letter, email, faxes) in a timely manner.
Records and maintains patient's health records in the agency's database (i.e. Nextgen, Provide) and other data systems and/or patient records as required.
Processes referrals for patient specialists visits including in house specialists and outside providers (via insurance portals, phone calls, etc)
Coordinates appointments for patients with specialists.
Ensures updates are made in EHR regarding appointments made for specialists, patients' attendance and/or comments, etc.
Process additional information requested by insurance companies for authorizations (medical records, documentation from providers, etc).
Assists in authorizations denials and appeals on behalf of the patient and documents outcomes in EHR.
Finds alternatives, as deemed necessary by providers, for denied authorizations.
Ensures external 3rd party documentation (i.e. labs, consultations reports, etc) is collected and entered in the patient's electronic health records (EHR).
Ensures proper and timely closing of tasks as it relates to referrals and open orders via EHR.
Medical Records:
Receives and documents medical records requests from outside agencies (Social Security Administration, legal offices, outside providers or patient request)
Prepares invoices for payments of medical records requests.
Prepares to medical records as requested by printing from EHR, and prepping for faxing or mailing.
Ensures documentation for new patients is collected and recorded in the patient's electronic health records (EHR).
Ensures patient documentation is fully completed and recorded in the agency's database (i.e. Nextgen).
Ensures proper tasking to the provider when records received and closing of tasks from providers when record obtained.
Quality Assurance/Compliance:
Assists in ensuring that the medical office (front desk and waiting area) is kept clean and tidy at all times.
Ensures online training is current as required
Ensures that medical operations fully comply with agency and HIPAA requirements.
Safety:
Ensures 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 agency's Continuity of Operations Plan (COOP).
Culture of Service: 3 C's
Compassion
•Greets internal or external customers (i.e. patient, client, staff, vendor) with courtesy, making eye contact, responding with a proper tone, and nonverbal language.
•Listens 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
•Provides services required by following established protocols and when needed, procure additional help to answer questions to ensure appropriate services are delivered
Commitment
•Takes initiative and anticipates 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
Ensures 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 and laboratory settings.
Other
Participates in health center developmental activities as requested.
Other duties as assigned.