Clinical Referral Specialist

• 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.

• 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.
• 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.

No Phone Calls Please. Qualified applicants may apply online, send a resume to Karyn Dowling, Talent Acquisition Specialist, Sixteenth Street Community Health Centers, 1337 S. 16th St., Milwaukee, WI 53204, or fax to . Sixteenth Street Community Health Centers is an equal employment opportunity employer.