Clinical Referral Specialist

Sixteenth Street Community Health Centers; Milwaukee (WI); Vor Ort; USD 36.000 - 60.000; Vollzeit

Zusammenfassung

Sixteenth Street Community Health Center, Inc. in Milwaukee is seeking a Referral Coordinator to support the clinic's referral and authorization processes. Hours are Monday–Friday, 8 am–5 pm, with no nights or weekends.

You will collaborate with clinical teams, registration, and Charity Care to navigate payer requirements, maintain EMR referrals, and ensure timely patient access to services for a diverse community.

Qualifikationen

• Minimum of 1 year of work experience in a health care environment.
• Medical terminology.
• Excellent oral and written communication skills.
• Strong Customer service skills.
• Ability to manage multiple tasks.
• Knowledge of basic office computer programs and typing are essential.
• Ability to relate well to people from diverse ethnic and cultural backgrounds.
• Bilingual (Spanish/English) required.

Aufgaben

• Reviews work queues to identify unscheduled ordered services and schedules the appropriate service.
• Knowlege of Medicare, Medicaid and third-party payer requirements, guidelines and policies, insurance plans requiring pre-authorization and current accepted plans.
• Notify the ordering provider through referral in basket message in EMR when an ordered medical service is removed.
• Provide high level patient service by problem solving, documenting concerns, and identifying follow-up.
• Understand authorization requirements, payer coverage, eligibility guidelines, and Charity Care systems.
• Act as liaison between patients and registration to update demographic, financial, and insurance information.
• Seek timely approval of referrals by providers.
• Track approvals and denials of prior authorizations and maintain referral outcomes trail in EMR.
• Communicate approvals and denials with patients and clinical teams via referrals in basket messages and Specialist offices as needed.
• Serve as a direct resource for clinical teams regarding referrals and authorizations and maintaining referral source information.
• Act as direct contact for patients navigating insurance or Charity Care systems as related to referrals.
• Maintain other resources to assist clinical teams for referrals and authorizations.
• Data entry for statistical reporting of referrals and related work.
• Comply with SSCHC TB Control Plan including PPD testing.
• Perform other duties as assigned.

Kenntnisse

Healthcare experience

Medical terminology

Communication skills

Customer service

Multitasking

Bilingual (Spanish/English)

Typing

Office software

Tools

EMR systems

MS Office

Jobbeschreibung

Looking for a job in healthcare with no nights and no weekends? Join our team dedicated to the highest quality health care!Hours: Monday - Friday, 8 am - 5pm

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.