Referral Clerk

Planned Systems International, Inc.; Portsmouth (VA); On-site; USD 35,000 - 45,000; Full time

Benefits offered by this job

Paid leave

Medical, dental, vision insurance

401(k) retirement plan

Tuition reimbursement

Job summary

Planned Systems International, Inc. is seeking a Referral Clerk for a government healthcare contract at Naval Medical Center Portsmouth, Virginia. The role involves managing patient referrals, coordinating appointments, and ensuring compliance with HIPAA regulations.

The ideal candidate must possess strong organizational and communication skills. Responsibilities include reviewing referrals, arranging medical appointments, and utilizing the MHS GENESIS system to maintain accurate patient records.

Qualifications

• Strong organizational skills to manage patient referrals and appointments.
• Excellent communication skills for interacting with patients and providers.
• Knowledge of HIPAA regulations for patient confidentiality.

Responsibilities

• Manage patient referral processes and coordinate specialty care appointments.
• Review referrals for administrative completeness and monitor timelines.
• Utilize telecommunications technology to collect external documentation.

Skills

Organizational skills

Communication skills

HIPAA compliance

Data entry skills

Education

High School Degree or GED

Tools

MHS GENESIS

Job description

Overview

QuarterLine (QL), a Planned Systems International (PSI) company, is seeking a dedicated and compassionate Referral Clerk to support a government healthcare contract at Naval Medical Center Portsmouth, Virginia, within a Department of Defense (DoD) medical treatment facility. The selected candidate will manage patient referral processes, including coordinating specialty care appointments, processing consults, tracking authorizations, and maintaining accurate records in accordance with contract requirements and clinical workflows. This role requires strict adherence to HIPAA, TRICARE, and DoD regulatory standards, ensuring timely and accurate handling of referrals to support continuity of care.

The ideal candidate will demonstrate strong organizational and communication skills while collaborating with providers, case managers, and external networks in a fast‑paced environment. This position requires a dependable professional who can meet government credentialing, security, and onboarding requirements while contributing to mission readiness and high‑quality patient care for service members and eligible patient populations.

Essential Functions and Job Responsibilities

Core Duties:

• Reviews referrals for administrative completeness and researches covered benefits prior to processing.
• Determines patient eligibility for services and arranges and schedules medical appointments for referred care.
• Provides general instructions to patients and MTF personnel regarding the referral procedures.
• Ensures referral results are returned to the referring provide and to the medical record within required timelines. Assists with follow up, written or verbal, as necessary.
• Utilizes the referral tracking data collection tool. Calculates metrics, and compiles monthly reports.

Specific Duties:

• Utilize the MHS GENESIS system to retrieve external medical documentation, termed Clear and Legible Reports (CLRs), and upload the results into the patient’s chart.
• Utilize telecommunications technology to collect external documentation for patients within NMC Portsmouth by contacting outside clinical practices to retrieve patient and service documentation.
• The expected daily target for contracted personnel is at least 70 CLRs on a standard workday and 50 CLRs on days focused on collecting external documentation.
• As needed, communicate with providers regarding CLRs if they are incorrect or need additional context; this communication is likely to come through MHS GENESIS.
• Review referral notes, including but not limited to; consultation, operative, and discharge summaries requested when a TRICARE Beneficiary is referred to external providers for care. Return these external documentations to the patient chart.
• Chase external notes from network providers for patients to upload into the patient chart for clear reporting of patient encounters through various telecommunication methods including phone, fax, and secure mail.
• Respond to provider queries regarding external provider notes and documentation.
• Ensure referral results are returned to the referring provider and to the medical record within required timelines. Assist with follow up, written or verbal, as necessary.
• Utilize the referral tracking data collection tool within MHS GENESIS and discern reporting system to measure amount of outstanding CLRs.

Minimum Requirements

• Degree/Education: High School Degree or GED.
• Legal Authorization to Work in the United States: The contract worker performing under this contract must be a U.S. Citizen.
• Certification(s): Basic Life Support (BLS) from the American Heart Association or the American Red Cross. Certification cards must display the American Heart Association or the American Red Cross. Web-based (on‑line) classes are not acceptable by the Government.

Additional Information

• Must pass TB Test.
• Subject to a background/security investigation.
• Willingness to comply with DHA vaccination requirements.
• Pre‑employment drug screening.
• Contract workers shall maintain good personal hygiene and present a well‑groomed and professional appearance IAW the policy at the place of performance.
• The work requires long periods of sedentary activity involving intense concentration and repetitive manual tasks. Some walking, standing, bending, and lifting of multiple files is involved. The work involves periods of rapidly changing pace requiring adequate stress management skills. Contracted personnel shall perform all duties in a professional and ethical manner.

Company Benefits

PSI offers full-time, benefits eligible employees a competitive total compensation package that includes paid leave, and options for employer sponsored group medical, dental, vision, short‑term and long‑term disability, life insurance, AD&D coverage, legal services, identity theft, and accident insurance. Flexible spending account and health saving account options offer pre‑tax savings for qualified medical, dental, and vision expenses. The company sponsored 401(k) retirement plan has an employer contribution match that is immediately vested. We invest in the professional growth of our employees through professional courses, certifications, and tuition reimbursement programs.

EEO Commitment

It is company policy to promote equal employment opportunities. All personnel decisions, including, but not limited to, recruiting, hiring, training, promotion, compensation, benefits, and termination, are made without regard to race, color, religion, age, sex, sexual orientation, pregnancy, gender identity, genetic information, national origin, citizenship status, veteran status, protected veteran status, disability, or any other characteristic protected by applicable federal, state, or local law. Reasonable accommodations for applicants and employees with disabilities will be provided. If a reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact Human Resources by emailing HRDepartment@plan‑sys.com, or by dialing 703‑575‑8400.