PRECERT/REFERRAL CLERK

Communicates with nursing staff, Precert/Referral Department and Physician offices to obtain referrals. Processes all “same-day” or “next day” prior authorization/pre-certifications for diagnostic procedures, and medication infusions/injections as ordered by the physician. Pleasant, courteous disposition with the ability to communicate effectively with insurance representatives as well as patients, employees and physicians. Professional in conduct and appearance.

1. Completes referral requests and files referral forms.
2. Ensures Referral order is entered into the Orders Management Module of the EHR.
3. Uses EHR Tasking to communicate ordered referrals to Pre-cert/Referral Dept.
4. Follows up on referral and ensures appointment date and time and communicates to patient.
5. Ensures post referral documentation is received and seen by physician and sent to HIM for Scanning.
6. Completes the referral in Orders Management Module to close Referral loop.
7. Contacts patients’ insurance companies by phone or use of Internet to acquire the pre-cert/prior-authorization information and allowed benefits for scheduled procedure.
8. Documents on the pre-cert form the date, person spoken to, allowable benefits and authorized pre-cert number.
9. Records authorization number in EHR.
10. Keeps a record on each contact with insurance companies by computer and file notes.
11. Faxes pre-cert information to hospital admissions as needed.
12. Answers telephone identifying self.
13. Returns phone calls in timely manner.
14. Floats to other areas as needed.
15. Disposes of biohazard waste according to clinic policy.
16. Uses universal precautions and personal protective equipment as needed.
17. Follows approved Electronic Health Record Security standards as outlined by Information Systems department.
18. Keeps work station neat and clean.
19. Attends OSHA and Fire Safety training annually.

1. High school education or equivalent.
2. Computer knowledge.
3. Good interpersonal skills.
4. Previous medical experience required.