Referral Authorization Clerk

Department

  • Shared position between Cardiology (Syracuse) and Primary Care (Syracuse)

Hours

  • Monday through Friday business hours (no evenings, weekends or Federal holidays)

Position Overview

Provides referral support for the professional teams through positive customer service, diagnostic appointment scheduling, processing insurance authorization, maintaining and organizing appropriate documentation, copying, faxing completed orders, and other clerical duties as required.  Works with the physicians, managers and staff to promote quality and cost effective daily operations. Establishes and maintains good interpersonal relationships with patients, their families, the public and co-workers. This position works collaboratively with all other staff to assist the patient and facilitate successful patient interaction with the practice team. This position reflects and carries forward the mission and goals of the practice both internally and throughout the community.

Responsibilities

  • Referrals and Authorizations
    • Verifies patient insurance information, contacts insurance carriers to obtain authorizations for diagnostic testing.
    • Generates diagnostic orders in EMR, faxes necessary supporting documentation along with script to testing facilities.
    • Demonstrates a clear understanding of the medical chart and has the ability to provide clear and accurate supporting clinical information as necessary to support the need for ordering tests.
    • Follows guidelines for testing, provides acceptable diagnosis for testing requested advises testing centers if diagnosis supplied for testing is non-covered and advises patient as necessary.
    • Demonstrates ability to look up and re-process prescriptions for diagnostic procedures.
    • Accurately documents clinical message in EMR, verifying spelling of name, phone number, and date of birth. Uses last four digits of the social security number or date of birth to look patients up in EMR.
    • Demonstrates computer skills to accurately maintain provider orders based on established policies and protocols.
    • Prepares supporting documentation and demonstrates the ability to print, fax and generate all required documentation necessary for referral as scheduled.
    • Demonstrates the ability to accurately determine ICD-9-cm and CPT codes for ordered tests.
    • Ensures the delivery of the Patient Centered Medical Home Standards through a care team approach.
  • Scheduling
    • Schedules outside testing and specialists appointments as required.
    • Effectively communicates information regarding testing appointments to patients.
    • Accurately documents all communication regarding appointments in EMR telephone templates, diagnostic ordering templates, and plan templates accordingly.
    • Tasks all patient appointments to the ordering physician’s nurse for follow up.
    • Accurately manages phone request by scheduling patients, documenting the message or contacting clinical team for support when required.
    • Follows established scheduling protocols and directs clinical concerns to appropriate provider staff member.
  • General Expectations
    • Daily documents clinical messages in EMR based on established policy and procedures.
    • Organizes charts based on office protocol, discards items per policy.
    • Copies/faxes charts requested by outside offices.
    • Accurately inputs patient’s demographic and insurance information into computer as needed.
    • Reviews all encounter forms for accuracy.
    • Immediately responds to patients in a positive, friendly, helpful manner.
    • Any and all other clerical duties as assigned.
  • Patient Care Environment
    • Demonstrates appropriate knowledge and expectations related to emergency procedures to implement in the event of the medical emergency, violence, fire, disaster or severe weather.
  • This individual is expected to assist in meeting the goals set forth by the Medical Director and Practice Administrator. This will include other duties as assigned by members of the management staff.

Access, Use and Disclosure of Patient Information

Position requires access to patient Protected Health Information (PHI) and individually Identifiable Health Information (IIHI) within the job responsibilities listed above. Employee is advised that inadvertent and/or intentional disclosure of this information violates Federal Law and can result in termination and/or fines.

Confidentiality

This individual is expected to maintain patient confidentiality and following all HIPAA guidelines, disclosing PHI only with appropriate parties, privately and as necessary according to company policy.

Qualifications

To perform this job successfully, this individual must understand and work well in a production-driven environment, meeting established benchmarks. This individual must understand and work well in a fast-paced and often times stressful environment. Referral and authorization clerk must demonstrate concern and empathy, providing excellent customer service while acknowledging physiological and psychological needs. To be successful, a referral and authorization clerk must have the ability to work well with others in a team environment and display sound judgment.   The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

  • Required Qualifications
    • High School diploma.
    • Minimum two years’ experience in healthcare.
    • Proven ‘team player’ experience.
    • Demonstrated experience in computer use.
    • Understanding of insurance carrier authorization process.
    • Knowledge of current ICD-10 and CPT-4 codes
  • Desirable Qualification
    • Demonstrated competence interpersonal and intra professional relations.
    • Associates degree or certificate from medical assisting or secretarial school.
    • Experience in medical terminology.
    • Knowledge of NextGen practice management system.

Crouse Medical Practice, PLLC is an Equal Opportunity Employer-M/F/D/V. To apply, please complete our Online Application or  email your resume to Human Resources at humanresources@crousemed.com.