Hybrid Referral Clerk- Professional Physician Center na None

Obtains information, insurance verification and authorization required for proper patient treatment and treatment. Receive, track and obtain insurance authorization from in-network and out of network insurance carriers for New Patient and follow up visits with our medical providers. Process physician referral orders using EMR system. This includes obtaining insurance authorization if needed. Coordinate new therapy referrals for insurance plans that require authorization. This includes obtaining any insurance authorization needed. Accurately enter notes into EMR system regarding letters or correspondence from insurance companies regarding insurance authorization or other notifications. These documents should also be scanned into the appropriate patients chart in EMR system. Remain updated with patients and insurances. Demonstrate and apply knowledge of medical terminology, high proficiency of general medical office procedures including HIPAA regulations. Protect patients’ rights by maintaining confidentiality of personal and financial information. Maintains operations by following policies and procedures; reporting needed changes. Contributes to Team effort by accomplishing related results as needed.  At all times must exemplify extremely high-quality customer services to both external patients as well and internal patients that meets or exceeds our standards of behavior at NLGH. Interfaces with Physician, staff, patients and families. These functions include not limited to, referral processing, facilitating completeness and accuracy of all new incoming referrals, routing to the correct specialty. Ability to prioritize multiple tasks at one time in a medical office setting, multi-phone system and medical terminology. Responding to referral inquiries over the phone, looking through referral cases, communicating all instances with concerned personnel. Tracking and documenting referrals, ensuring completions of registration and insurance information. Ensures referral and scheduling related activities are transparent at each step to the referring provider and patient by initiating update calls/letters/emails and secure chat to either the patient or referring provider. If deemed appropriate, arrangements shall be made for the patient to be screened either by transporting the patient to the treatment program or by staff seeing them in the community.  

• Referrals in work queue are to be worked daily, including facilitating completeness and accuracy of all referrals, routing to the correct specialty. Referrals are to be accepted, assigned and attached to the patient’s appointment. Tracking and documenting referrals, ensuring completions of registration and insurance information.
• New referrals must be processed within 2 to 3 business days, pending referrals must be processed within 5 business days. Communicating with patients on any delays in care, updates, insurance, test results, imaging and authorization as needed. 
• Ensures referral and scheduling related activities are transparent at each step to the referring provider and patient by initiating update calls/letters/emails and secure chat to either the patient or referring provider including: Date and time of referral , Patient’s name, sex, date of birth, address, phone number, and social security number. Referral source information, including organization, name of person originating referral, title, phone number, and organization address. Name of caller if different from above and his/her relationship to the patient. Insurance information, Medicare number, name and number of secondary policies, if applicable.  Presenting problem/chief complaint
• Verify demographics Ensuring completion of registration and insurance information.  and any other pertinent information prior to patient visit to clinic. Ensuring that all paperwork is completed accurately and efficiently within 10 business days
• Communicate with the referring office/ patient throughout the referral process from start to finish informing of delays or additional items needed prior to scheduling up to scheduling. All communication must be documented in detail within the referral communication note tab. If unable to reach a patient after 3 communication attempts within 14 business days, finalize process with a mailed letter communicating closure of referral due to no contact.  
• Works specifically with referring providers at assigned Network member sites to understand their preferences for communication about patients’ test results, treatment plan recommendations, treatment progress
• Facilitate financial counselor review or consultation for patients that do not have insurance or are underinsured per standard work

Values
i - Innovation
"Think Forward" "Set Out-Of-The Box Goals" "Exploring new possibilities" I am the change agent that advocates for our customers. I think outside of the box to create Exceptional experiences that set us apart. I look for solutions and think of new ways to solve problems, even if it is outside of my department.
 
 
C - Compassion
"Demonstrate genuine concern" "Display a Selfless attitude" I show kindness in every interaction. I strive to build trust with our co-workers and customers. I will communicate with our co-workers and customers in a way they understand. I will make time to address our co-workers and customers' needs.
 
 
A - Accountability
"Show integrity" "Accept Ownership & Responsibility" I will demonstrate integrity by doing the right thing, being honest and having strong moral principles. When mistakes occur, I take the necessary steps to correct them, without dismissing patient concerns and follow through until resolution. I fully document actions taken to ensure continuity of care. I communicate expectations and follow up within defined time frames and provide updates as I understand them for my customers and teammates.
 
 
R - Respect
"We value diversity" "Respect is earned" I treat all people with dignity and respect, regardless of their beliefs. I do not use negative/derogatory language. I accept constructive feedback and suggestions for the greater good.
 
 
E - Empowerment
"Share Knowledge" "Take Action" I will share knowledge to empower others and encourage them to make informed decisions. I encourage others to reach their full potential. I will encourage trying new things, diverse ideas, and learning from our mistakes. I have the freedom to do what is right for our customers. 

ORGANIZATION EXPECTATIONS:

Communication

The process of sending and receiving messages with words, verbally, written or in sign language.

Customer Focus

Identifying and responding to current and future patient and other customers’ needs; providing excellent service to internal and external patients and other customers.

Initiative

Identifying and dealing with issues proactively and persistently; seizing opportunities that arise.

Self-Development

Lifelong, voluntary, and self-motivated learning.

Teamwork

Effectively work and complete assignments in group settings. Works independently and cooperatively with others to achieve common goals.