Referral Clerk (FT)

REFERRAL CLERK Twenty-Nine Palms AAI is actively looking for a referral Clerk.
Position Overview: This position provides clerical/administrative support in the Referral Management Center for customer service, referral tracking, referral appointing, and reporting activities.
This position will support the daily functions of specialty care referral appointing, referral review and coordination, beneficiary counseling, and referral tracking at the MTF.
RESPONSIBILITIES: A fully qualified typist with a minimum of 50 WPM is required.
Demonstrate general medical ethics, telephone etiquette, and excellent communication and customer service skills.
Possess general office administrative and clerical skills to perform receptionist duties and answer telephones.
Ability to communicate effectively, both orally and in writing.
Work Environment/Physical Requirements: The work is primarily sedentary.
However, there may be some physical demands.
Requirements include prolonged walking, standing, sitting, or bending.
Possess experience producing documents that require complex formats to edit, update, or re-write to make clear and revise existing complex word processing documents or spreadsheets.
The contractor shall use various software applications to record, retrieve, correct, merge, query, or print data and reports.
Programs and software utilized by the Government and TRICARE contractor include, but are not limited to, the Defense Enrollment Eligibility Reporting System (DEERS), access to databases, electronic fax applications, Referral Management System/Referral Management System Tracking and Reports, Healthcare Artifacts and Image Managements Solution (HAIMS), and Electronic Medical Record databases.
The contractor shall use Microsoft Office products including: Outlook, Word, Excel, and Access.
REQUIREMENTS: Education.
High school diploma or General Educational Development (GED) equivalency.
Completion of an Administrative Assistant program is desired.
Experience.
At least 6 months of experience in a medical office setting.
Possess and maintain current certification in American Heart Association Basic Life Support (BLS) for Healthcare Providers.
Training shall be the responsibility of the contractor and is at no cost to the Government.
Contract workers not currently in possession of current certification must acquire certification prior to initiating contract performance.
Web-based classes do not meet these standards.
Certification Card must display the American Heart Association or Military Training Network Emblem.
UNIQUE MILITARY HEALTH CARE SYSTEMS/PROCEDURES: The MHS GENESIS or other MTF ICD-B programs must be utilized for referral management services.
Access will be granted by local MTF connectivity and the contractor shall comply with MHS communications and Government IT security standards and policies.
The military facility will provide system accounts for MSS personnel after the required training and security procedures have been completed by the contractor.
If the Military Health Service processes move away from specified systems, the government will modify the task order accordingly.
PERFORMANCE OUTCOMES: Note: All specialty care and Right of First Refusal (ROFR) referrals/consults shall be managed per current DHA and MTF referral management policies and guidance.
All specialty care referrals will be appointed to the MTF/Direct Care System within prescribed Access to Care (ATC) Standards or referred to the local network.
Greets patients/visitors at a front desk, referral center, or office setting.
Answers main office phone line(s).
Directs telephone calls to the appropriate section for assistance, handles independently, or takes messages as required.
Review all incoming CLR referrals for administrative accuracy, completeness, and legibility, and posting of post-consultation reports for patients referred both to and from providers Determines patient eligibility for services, arranges and schedules medical appointments for referred care, and contacts the physician’s office, if an incoming report does not meet the CLR standards.
Provides general instructions to patients and ensures patients have the necessary documentation for referred health care services.
Obtains updates and files medical records as needed.
Organizes and researches patient records, extracts needed information, and reviews records for referral results within established guidelines.
Request medical records and ensure the arrival of medical records prior to appointment(s).
Initiates and locates patient medical records as needed.
The contractor shall establish and maintain suspense files for referrals deferred to the network and compile and maintain data for reporting and tracking purposes.
Obtains documentation as requested by healthcare providers (test results, or documentation not yet filed in records), provides CLR receipts validation, and shall cross-check referral authorizations against claims adjudicated.
Ensures referral results are returned to the referring provider and to the medical record within required timelines.
Assists with follow-up, written or verbal, as necessary.
Notifies MTF providers when a CLR is posted and monitors timelines of incoming CLRs.
Utilizes the referral tracking data collection tool.
Calculates metrics and compiles monthly statistic reports which includes the number of actions processed each month.
It is estimated that approximately 20,604 administrative referral transactions will occur during a twelve (12) month period; to include telephone consults (Tcons) into MHS Genesis.
The workload may increase depending on the availability of specialists or specialty support services at the MTF and the unexpected influx in the number of beneficiaries to the area.
Contact Provider and network provider offices to determine if the patient was seen and if so, acquire referral results.
The contractor shall properly close referrals in MHS Genesis and the Referral Management System/Referral Management System Tracking Reports appropriately and shall forward informational advisement of the referral status to the initiating MTF provider or PCM.
Contacts shall be documented per MTF instruction.
Properly document patient responses in MHS Genesis, and the Referral Management System/Referral Management System Tracking Reports and HAIMS.
The contractor shall provide notification to the referring Provider of patient requests to cancel referrals.
Assist with the return of completed consult reports to civilian providers for patients seen within the MTF under ROFR.
ROFRs shall be processed within the time limits outlined in the TRICARE Operations Manual, Chapter 8, Section 5 (https://manuals.
tricare.
osd.
mil/DisplayManual.
aspx?SeriesId=OPERATIONS).
About AAI AAI is focused on delivering outstanding services to the federal government.
We have extensive experience in the fields of cyber security, development, IT infrastructure, supply chain management, and other professional services such as system design and continuous improvement.
AAI is a VA CVE-certified Service-Disabled Veteran-Owned Small Business (SDVOSB), SBA-certified Economically Disadvantaged Woman Owned Small Business (EDWOSB), and a Woman Owned Small Business (WOSB) with offices in Hampton Roads Virginia, Montgomery, AL, Washington DC and Atlanta.
Fully qualified candidates are welcome to apply directly on our website at: https://aaionline.
us/.
Our benefits include: Paid Federal Holidays Robust Healthcare and Dental Insurance Options 401a plan 401k plan Paid vacation and sick leave Continuing education assistance Short Term / Long Term Disability & Life Insurance.
Veterans are encouraged to apply AAI does not discriminate in employment opportunities, terms and conditions of employment, or practices on the basis of race, age, gender, religious or political beliefs, national origin or heritage, disability, sexual orientation, or any characteristic protected by law.
Pending guidance from the Safer Federal Workforce, employees may in the future be required to provide evidence of COVID-19 vaccination or request and receive approval for a medical or religious exemption.