Outside Referral Clerk

Job Summary

Under supervision, maintains current records of all physician outside referrals; verifies that outside referrals have proper authorization for prescribed services; monitors expenditures to determine appropriateness of payment per establishes guidelines and sets up reporting systems for the processing of forms required for outside referrals and the payment of outside services rendered.

Essential Responsibilities

This description is for recruitment posting purposes only. It has not received full HR review and approval.

• Patient/Member Care.
• Answer member inquiries.
• Information and Records.
• Enter data into automated systems.
• Print and distribute computer reports.
• Answer and route telephone calls.
• Organize and maintain department files, records, handbooks and manuals.
• Remove deactivated files for storage.
• Finance/Accounting.
• Review incoming invoices and payment request documents for approval authority.
• Return unauthorized documents.
• Sort bills by type and forward to appropriate department.
• Maintain records of outside referrals.
• Verify outside referrals have proper authorization for prescribed services.
• Monitor expenditures to determine appropriateness of payment.
• Review bills for outside referral services and verifies charges.
• Contacts outside physicians/hospitals when changes do not correspond to authorized services.
• Maintain statistical reports on outside referral activity and charges.
• Materials and Supplies.
• Operate copier equipment.
• Other Activities and Responsibilities.
• Assume other activities and responsibilities from time to time as directed.
  
  

Experience

Basic Qualifications:

• Medical Terminology or one (1) year experience in Medical Field.
• Typing 40 wpm.
• Typing score must be current within one (1) year.
• Please contact Human Resources for testing.
• Effective interpersonal skills.
• Able to work with diverse groups of individuals.
• Consistently demonstrates the knowledge, skills, abilities and behaviors necessary to provide superior and culturally sensitive service to each other, to our members and to customers, contracted providers and vendors.
• ICD-9 and CPT coding certificate or equivalent experience.
• Effective interpersonal skills.
• Able to work with diverse groups of individuals.
• Consistently demonstrates the knowledge, skills, abilities and behaviors necessary to provide superior and culturally sensitive service to each other, to our members and to customers, contracted providers and vendors.
  
  

Education

• N/A
  
  

License, Certification, Registration

• N/A
  
  

Additional Requirements

Preferred Qualifications:

• N/A
  
  

Notes

• This is an on call position, days and hours may vary.