Referral Clerk

Coplin Health; United States; Remote; USD 42,000 - 54,000; Full time

Job summary

Coplin Health is seeking a referral clerk to coordinate all patient referrals across departments, ensuring timely processing and accurate documentation within the EMR.

The role involves liaising with providers, insurers, and care teams to secure approvals, track status, and communicate with patients. Strong HIPAA compliance and customer service are essential.

Qualifications

• Strong communication and HIPAA confidentiality.
• Professional demeanor with patients and coworkers.
• Excellent customer service and computer skills.
• Knowledge of medical terminology and workflow processes.

Responsibilities

• Maintains ongoing tracking and documentation on referrals in the EMR to promote team awareness and patient safety.
• Ensures complete registration including demographics and insurance in the EHR.
• Prepares and assembles patient health and demographic information for referrals.
• Contacts organizations and insurers to meet prior approval requirements.
• Documents tests and imaging needed for referrals in the patient record for access by the referral team.
• Assists with scanning and reviewing referral documentation and radiology results in the patient record.
• Keeps patients informed of appointment dates and times.
• Reviews referral details with patients and sets expectations.
• Ensures referrals are addressed in a timely manner.
• Assists patients with barriers related to care, finances, or transportation, and arranges interpreters if needed.
• Acts as navigator/contact for patients and supports advocacy with carriers.
• Maintains relationships with service providers and updates referral lists.
• Keeps primary care chart current with specialist consults and hospital events.
• Provides input on best practices for workflow and updates team as needed.
• Performs other duties including updating care team on new specialists and supporting front desk/records.

Skills

Communication

Confidentiality

Professionalism

Customer Service

Computer Skills

Medical Terminology

Reasoning Ability

Cultural Competence

Education

NRCMA/LPN preferred

Associate’s degree + experience considered

Job description

Remote

JOB STATEMENT/SUMMARY

The referral clerk is responsible for coordinating all service referrals for patients at Coplin Health Systems. Referrals may be from any department within the organization; primary care, dental, pediatrics and/or behavioral health.

ESSENTIAL FUNCTIONS & RESPONSIBILITIES OF THE POSITION

• Maintains ongoing tracking and appropriate documentation on referrals in the electronic medical records system to promote clinical team awareness, ensure continuity of care and patient safety.
• Ensures complete and accurate registration, including patient demographic and current insurance information documented within the patient electronic health record.
• Prepares and assembles necessary patient health and demographic information needed to complete referral ordered by the provider.
• Contacts organizations and insurance companies to ensure prior approval requirements are met.
• Assures necessary laboratory testing, imaging, tests, etc. required for the referrals are documented in the patient record and available to be forwarded as required for the respective referrals. If laboratory testing, imaging, or other tests, etc. have not been completed and documented for the referral, clerk will alert ordering provider of outstanding needs through the electronic health record through an Action.
• Assists Medical Records Clerks with scanning and reviewing completed referral consultation documentation, testing and radiology results in the patient’s electronic record upon completion of referral. Assures provider was notified of any urgent abnormal results.
• Keeps patients informed of their appointment dates/times.
• Reviews details and expectations about the referral with patients.
• Ensures that referrals are addressed in a timely manner.
• Assists patients in problem solving potential issues related to the health care system, financial or social barriers (e.g., request interpreters as appropriate, transportation services or prescription assistance).
• Serves as the system navigator and point of contact for patients, families, and may assume an advocate role on the patient's behalf with the carrier to ensure approval of the necessary supplies/services for the patient in a timely fashion.
• Identifies and utilizes cultural and community resources, establishing and maintaining relationships with service providers (e.g., DME, Home Health, Oxygen companies) and keeping an updated list of referral providers and facilities. Notifies co-workers when changes or additions are identified.
• Assists in ensuring that patient's primary care chart is up to date with information on specialist consults, hospitalizations, ER visits and community organization related to their health.
• Provides input on best practices regarding workflow.
• Performs other duties as assigned, including updating the care team as new specialists are obtained and assisting front desk and medical records.

JOB REQUIREMENTS AND PREFERRED QUALIFICATIONS

Competencies

• Communication (spoken and written)
• Confidentiality (according to HIPAA guidelines)
• Professionalism (with patients, colleagues, and others)
• Excellent Customer Service
• Computer Skills
• Medical Terminology
• Reasoning Ability
• Cultural Competence (sensitivity to the mission of CHS)

Education (level and type) and Related Work Experience

• Candidates with an NRCMA and/or LPN are strongly preferred. Candidates with an associate’s degree and experience in referral/patient navigation and/or billing/medical records will be considered.