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    Lead Referral Clerk - Clovis, United States - Central Valley Indian Health Inc

    Central Valley Indian Health Inc
    Central Valley Indian Health Inc Clovis, United States

    3 weeks ago

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    Description


    Central Valley Indian Health, Inc. (CVIH) is seeking qualified candidates for the position of Lead Referral Clerk. This position coordinates and oversees the activities of the Referral Clerk staff to ensure CVIH protocols are being followed and professional care is provided to patients. The Lead coordinates staff coverage when needed, and works closely with the Business Office Manager on any patient or staff issues. In addition to supervisory duties, the Lead will perform all functions of a Referral Clerk, including the preparation, tracking & processing of referrals made by a CVIH medical provider. Provides purchase orders to authorize services paid for by CVIH, and must maintain HIPAA compliance.

    PRIMARY RESPONSIBILITIES:
    1. Train new Referral Clerk staff on CVIH policies, protocols, and workflows.
    2. Coordinate Referral Clerk staffing coverage for all CVIH clinics.
    3. Responsible for auditing all Referral Clerk referrals to ensure timely processing of outgoing authorizations & that referrals are being done with appropriate documentation.
    4. Responsible for keeping the Specialist Provider List up to date.
    5. Work closely with the Business Office Manager on any patient or staff issues.
    6. Obtain referrals from the provider through the Electronic Medical Record system.
    7. Obtain current insurance information from patient. Check and complete pre-authorization requirements with the patient's insurance payer.
    8. Refer patients, who do not have insurance or other alternate resource, to Patient Representative for alternate sources assistance. Communicate with Patient Representative to coordinate referral appointment and processing.
    9. Obtain all necessary attachments to process an open referral to an outside provider.
    10. Obtain consultation reports after patient appointment by calling the outside provider or faxing a follow up report.
    11. Contact outside providers to set up appointments. Notify patients of scheduled appointments by phone and by mailing an appointment letter.
    12. Communicate and correspond with outside agencies & patients regarding referral submission.
    13. Document and track referrals following General Referral Guidelines (Fiscal Policies & Procedures).
    14. Facilitate communication between patients regarding the referral status.
    15. Perform general office duties; including typing routine correspondence, reports, and prepares documents as required within set deadlines.
    16. Answer telephone in a courteous and efficient manner; provide information to callers or route calls to appropriate person.
    17. Attend and participates in staff meetings and other related meetings as assigned.
    18. Perform or assist PRC staff with other duties as needed.
    19. Maintain assigned actions and follow-up on due dates.
    20. Maintain patient confidentiality according to CVIH standards and protocols.
    21. Communicate in a friendly and professional manner to others. Provide excellent service/support to all patients, employees, and outside contacts.
    22. Any other duties assigned to the employee by supervisor or CVIH Administration.
    Requirements

    1. High School Diploma or equivalent.
    2. Two years experience in processing medical paperwork and/or claims for patients.
    3. Knowledge of CPT, ICD-10 coding and how insurance companies' process claims.
    4. Must be computer literate; able to use web-based applications, word processing.
    5. Valid CPR Certificate preferred.
    6. A valid California Driver's License and clean driving record with the ability to be insured under CVIH's automobile insurance.
    7. Requires an awareness and keen appreciation of Indian traditions, customs a socioeconomic need; an ability at times to meet and deal effectively with Indian health organizations consisting of numerous tribes with varied cultures which requires tact, courtesy, discretion, resourcefulness, and good judgment in handling functions of a sensitive nature.
    8. "Safety Sensitive" positions are subject to random drug testing and are required as a condition of continued employment.
    CVIH is an equal opportunity employer; however preference in hiring is given to qualified Native American Indians in accordance with the Indian Preference Act (Title 25 U.S. Code, Section 472 and 473). Applicants claiming Indian preference must submit verification of Indian descent certified by tribe of affiliation or other acceptable documentation of Indian heritage. Qualified Veterans must submit form DD214 "Honorable Discharge". A copy must be attached with application.

    Candidates must submit the Central Valley Indian Health employment application in order to be considered for the position.
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