Referrals & Medical Records Clerk

JOB SUMMARY

The Referrals & Medical Records Clerk is primarily responsible for administrative duties and support within the medical department primarily related to referrals, authorizations, and medical records.

JOB RESPONSIBILITIES

Administrative Duties:

• Routes clients/patients to the appropriate areas within the agency.
• Answers phones, checks and returns voice messages in a timely basis.
• Updates patient’s demographic in agency’s data systems as appropriate.

Referrals/Authorization:

• Verifies patient insurance carrier/coverage to ensure proper processing of referrals.
• Responds to all correspondences and tasks (via letter, email, faxes) in a timely manner.
• Records and maintains patient’s health records in agency’s database and other data systems.
• Processes referrals for patient specialist’s visits including in house specialists and outside providers (via insurance portals, phone calls, etc.)
• Coordinates appointments for patients with specialists.
• Ensures updates are made in EHR regarding appointments made for specialists, patients’ attendance and/or comments, etc.
• Process additional information requested by insurance companies for authorizations (medical records, documentation from providers, etc.).
• Assists in authorizations denials and appeals on behalf of the patient and document outcomes in record system.
• Identifies alternative solutions, as determined necessary by providers, for denied authorizations.
• Ensures external 3rd party documentation (i.e. labs, consultation reports, etc.) is collected and entered in the patient’s electronic health records (EHR).
• Ensures proper and timely closing of tasks as it relates to referrals and open orders via EHR.