Clinical Referral Specialist

Sixteenth Street Community Health Centers; Milwaukee (WI); On-site; USD 35,000 - 45,000; Full time

Job summary

Sixteenth Street Community Health Centers in Milwaukee is seeking a patient services representative. The role involves scheduling services, handling authorizations, and supporting patients with insurance processes.

The ideal candidate has at least 1 year of healthcare experience, is bilingual (Spanish/English), and possesses excellent communication and customer service skills. Join a dedicated team focusing on high-quality patient care.

Qualifications

• Minimum of 1 year of work experience in a health care environment.
• Previous referral department employment preferred.
• Medical terminology familiarity required.
• Ability to relate well to people from diverse backgrounds.

Responsibilities

• Review work queues to connect with patients and schedule services.
• Notify providers about ordered services removed according to protocols.
• Provide high-level patient service through problem-solving and documentation.
• Assist in updating patients' demographic and insurance information.

Skills

Excellent oral and written communication skills

Strong customer service skills

Ability to manage multiple tasks

Bilingual (Spanish/English)

Job description

Join our team committed to the highest quality healthcare!

Job Responsibilities

1. Reviews work queues to identify unscheduled ordered services and connects with the patient to schedule the appropriate service.
2. Knowledgeable of Medicare, Medicaid and third-party payer requirements, guidelines and policies, insurance plans requiring pre-authorization and current accepted insurance plans.
3. Responsible for notifying the ordering provider through referral in basket message in electronic health record when an ordered medical service is removed according to the department's assigned removal reasons.
4. Provides the highest level of patient service by problem solving, documenting patient concerns, and identifying appropriate follow-up for patients.
5. Understands the process of authorization requirements, payer coverage, eligibility guidelines, and Charity Care systems.
6. Is a liaison between patients and registration department to assist in updating demographic, financial, and insurance information.
7. Seek timely approval of referrals by providers.
8. Track approvals and denials of prior authorizations in work queues and maintain trail of referral outcomes via EMR.
9. Communicate approvals and denials with patients, clinical teams via referral in basket message and Specialist offices as needed and requested.
10. Act as a direct resource for clinical teams as it pertains to initiating referrals, obtaining authorizations for referrals, and maintaining referral source information.
11. Act as a direct contact and information source for patients navigating their insurance or Charity Care systems as it pertains to referrals.
12. Timely maintenance of other resources to assist clinical teams as it pertains to initiating referrals and obtaining authorizations for referrals.
13. Data entry for statistical reporting of referrals and related work.
14. Comply with SSCHC TB Control Plan including PPD testing.
15. Perform other duties as assigned.

Qualifications

1. Minimum of 1 year of work experience in a health care environment. Previous referral department employment preferred.
2. Medical terminology.
3. Excellent oral and written communication skills.
4. Strong Customer service skills.
5. Ability to manage multiple tasks.
6. Knowledge of basic office computer programs and typing are essential.
7. Ability to relate well to people from diverse ethnic and cultural backgrounds.
8. Bilingual (Spanish/English) required.