Referral Clerk

Decypher is a leading integrator of professional, technology, and management solutions and services. We provide our services globally to Federal, Commercial, Local and State clients. Our employees are our most valuable asset and play an integral role in the success of Decypher and our clients. Working at Decypher is not a job, but a career where your talent and energy is respected, and you can personally make a difference. Decypher invites you to join our professional team.

Decypher is seeking a Referral Clerk to support Naval Medical Center Camp Lejeune in Jacksonville, North Carolina. U.S. Citizenship is required.

Qualifications

• Education/Degree: High school diploma or General Educational Development (GED) equivalency.

At Decypher we believe that equal opportunity fuels innovation by using the strengths of individual differences. Therefore, we strive to provide a welcoming and inclusive work environment. Decypher is fully committed to a program of equal opportunity for all applicants and employees and will actively carry out all federal and state regulations and executive orders. We apply our equal opportunity policy to all employment decisions.

Responsibilities

• Reviews referrals for administrative completeness and researches covered benefits prior to processing.
• Determines patient eligibility for services and arranges and schedules medical appointments for referred care.
• Provides general instructions to patients and MTF personnel regarding the referral procedures.
• 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.
• Utilizes the referral tracking data collection tool. Calculates metrics, and compiles monthly reports, as directed by the MTF.
• Referral Clerk shall participate in the Referral Management Program as stated in the Standard Operating Procedure (SOP), ensuring compliance with applicable processes, procedures, process timing parameters and other published guidelines. The SOP is the "go to" information that identifies all Referral Management Center (RMC) procedures and processes. The contractor shall review and be familiar with the SOP.
• Identify and track eligible beneficiaries each month, who have been authorized to receive specialty care outside of the medical capabilities of the MTF. Must ensure accurate collection and input of patient care data in approved databases, electronic medical records and reports.
• Generate the following weekly reports utilizing government systems and provide them to the Department Head and to the II MEF (Marine Expeditionary Force) point of contact:
  
  
  
  • NMCCL referrals not activated report.
  • Pending appointments report.
  • No-show report.
  
  
  
  
• Maintain liaison with Case Managers assigned to oversee the care of selected individuals to enhance clear and coordinated communications to minimize the duplication of effort.
• Process Right of First Refusal (ROFR's) network referrals each month following utilizing the Referral Management SOP guidelines. This includes provider research, review and update of patient information, patient registration, entering specialty consult, review and process through multiple databases. Each ROFR accepted by the MTF shall include a processed CLR that is faxed or mailed to the network PCM. Each ROFR takes approximately 5-10 minutes to process depending on the complexity.
• Participate in weekly meetings held by Referral Management Leadership to pass command information and to ascertain any department issues.
• Monitor clinic queues as assigned to ensure referrals are closed appropriately at 120 days or deferred to network are closed at 180 days.

This job description is not intended to be all inclusive. Therefore, the employee may be requested to perform other reasonable duties as assigned by the immediate supervisor or other management as required.

Note: This position is expected to be filled at a later date. Applications are still encouraged, and qualified candidates will be contacted when the hiring process begins.