Clinical Referral Specialist

Sixteenth Street Community Health Centers
United States, Wisconsin, Milwaukee
1337 South Cesar E Chavez Drive (Show on map)
Feb 04, 2025
Reviews work queues to identify unscheduled ordered services and connects with the patient to schedule the appropriate service. Knowledgeable of Medicare, Medicaid and third-party payer requirements, guidelines and policies, insurance plans requiring pre-authorization and current accepted insurance plans. Responsible for notifying the ordering provider through referral in basket message in electronic health record when an ordered medical service is removed according to the department's assigned removal reasons. Provides the highest level of patient service by problem solving, documenting patient concerns, and identifying appropriate follow-up for patients. Understands the process of authorization requirements, payer coverage, eligibility guidelines, and Charity Care systems. Is a liaison between patients and registration department to assist in updating demographic, financial, and insurance information. Seek timely approval of referrals by providers. Track approvals and denials of prior authorizations in work queues and maintain trail of referral outcomes via EMR. Communicate approvals and denials with patients, clinical teams via referral in basket message and Specialist offices as needed and requested. Act as a direct resource for clinical teams as it pertains to initiating referrals, obtaining authorizations for referrals, and maintaining referral source information. Act as a direct contact and information source for patients navigating their insurance or Charity Care systems as it pertains to referrals. Timely maintenance of other resources to assist clinical teams as it pertains to initiating referrals and obtaining authorizations for referrals. Data entry for statistical reporting of referrals and related work. Comply with SSCHC TB Control Plan including PPD testing. Perform other duties as assigned. QUALIFICATIONS: Minimum of 1 year of work experience in a health care environment. Previous referral department employment preferred. Medical terminology. Excellent oral and written communication skills. Strong Customer service skills. Ability to manage multiple tasks. Knowledge of basic office computer programs and typing are essential. Ability to relate well to people from diverse ethnic and cultural backgrounds. Bilingual (Spanish/English) required.