RESPONSIBILITIES:

Provide comprehensive assistance with referrals for patients of the East Harlem Council for Human Services, Inc. (Council)/Boriken Neighborhood Health Center (Boriken).  Contribute to performance improvement, staff development, and other programmatic and clinical functions.

DUTIES:

1. Schedule and confirm patient diagnostic appointments, surgeries and medical consultations.

2. Ensure that patient’s insurance allows them to access services of specialty provider, or identify affordable alternative for uninsured or underinsured patient. Complete pre-certification process when necessary to ensure insurance coverage.

3. Maintain data on referrals and report data.

4. Performs patient referrals and authorizations by completing and submitting documents and discussing with providers, insurance carriers and patients.

5. Ensure that follow-up referral appointments and reports were received, documented in the medical record and tracked.

6. Prepare for chart review prior to the patient visit.

7. Participate in internal and external meetings as directed by supervisor.

8. Foster linkages with other institutions providing services to patients and their families. Coordinate referrals to services with the staff of other institutions.

9. When necessary, perform functions of Patient Account/Data Processing Clerk:
   1. Process new patient registration information (collect support documents, enter patient data into computer system, generate encounters, etc.)
   2. Verify information annually obtained on family composition, income, financial resources, third party eligibility status, etc.

East Harlem Council for Human Services, Inc.

BORIKEN NEIGHBORHOOD HEALTH CENTER

JOB DESCRIPTION: REFERRAL SPECIALIST

PAge 2 of 2

1. Pre-register patients via telephone and make follow-up appointments using the current information system.
2. Schedule sub-specialty appointments for patients referred by provider to outside institutions.
3. Collect all patient payment fees including co-payment, co-insurance, deductibles, etc.
4. Investigate potential sources of reimbursement, such as third party insurance, Medicaid, managed care, unions, etc.
5. Compile encounters collected in Patient Accounts area with signed original encounters collected in the clinical areas.
6. Prepare daily cash receipt payment, submit report and cash collection to the Fiscal Department for deposit.
7. Input patient demographic and billing information from encounters into the information system (patient visit, diagnosis, procedures, etc.).
8. Post all patient payment information into the current information system.
9. Transmit electronically or on paper, patient billing information, verify billing transmission accuracy and completion.
10. Prepare all statistical and financial reports, as requested.
11. Prepare and verify back-up tapes daily.

10. Perform other functions necessary for the proper care of patients and functioning of the Council.

SUPERVISED BY: Director of Operations

QUALIFICATIONS:

High School Diploma or GED Required. Associate or Bachelor Degree with two years related work experience preferred.

Excellent written and oral communication skills and ability to multi-task.

Bilingual Spanish strongly preferred.

Experience working with individuals living with HIV/AIDS, people with a history of substance use and mental illness, homeless persons, domestic violence survivors and families at risk.

Computer literacy including electronic health records (eCW preferred), secure email, Microsoft Office.

Knowledge of medical terminology, ICD-10/CPT Codes, and insurance providers preferred.

Dedicated to providing high quality, patient-centered services to support positive health outcomes.