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Providence Health & Services Referral Coordinator in Santa Monica, California

Description:

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Applicants that meet qualifications will receive a text or email with additional questions from our MODERN HIRE screening and interview system.

Providence is calling a Referral Coordinator (Full time/Day shift) to Providence St. John Medical Foundation in Santa Monica, CA.

We are seeking a Referral Coordinator who will obtain authorizations for patient referrals to specialists, diagnostic testing and surgeries. Collect and verify insurance authorization requirements to ensure payer requirements are met in a timely manner. Effectively communicate with internal and external customers including medical providers, clinic staff, and insurance companies. Maintain ongoing tracking and appropriate documentation on referrals and authorizations via computer system and/or manual systems.

In this position you will:

  • Obtain authorization with third party insurance companies for referrals to specialists, diagnostic testing and surgeries:

  • Is familiar with the different insurances and processes for obtaining referrals

  • Coordinate with providers and clinic staff to ensure appropriate authorizations are obtained:

  • Develop internal workflows to facilitate authorizations and referrals for scheduled procedures

  • Verify insurance coverage and authorization requirements for referral orders:

  • Maintain access to necessary online and direct contact information in order to verify insurance coverage and process referral orders.

  • Provide specialists office with medical records of primary care:

  • Able to access and retrieve medical records and forward to necessary providers

  • Review scheduled appointments and ensure that required authorization and/or referrals are in place prior to patient visits:

  • Able to identify scheduled appointments that require authorizations or referrals and provide necessary support to obtain them prior to the visit

  • Monitor all assigned work queues and processes ensure that referrals and authorizations are responded to in a timely manner:

  • Daily review work queues in order to obtain or process for necessary referrals and authorizations

  • Assist with prioritizing work activities including evaluating and modifying processes when necessary:

  • Manage daily workload in order to process referrals and authorizations in a timely manner so as not to impact revenue collection. Regularly reviews work activities with clinic leadership

  • Maintain confidentiality of records, patient, employee or medical center information at all times. Ensure all information and conversations regarding patients are secured from general public access:

  • Confidential information and conversations are secure from public access

  • Ensure all faxes and communications adhere to federal regulations

  • Understands the application of HIPAA regulations to the workplace

  • Participation in unit/department staff meetings and in services:

  • Participate in unit/department staff meetings and in services to develop and implement processes that support quality patient care and effective work performance improvement

  • Participation in all mandatory staff meetings and in services and training programs:

  • Participate in all staff meetings and mandatory in service and training programs to ensure continued understanding of department policies, procedures and performance improvement

  • Maintain confidentiality of records or medical center information at all times:

  • Confidential information & conversations are secured from general public access

  • Ensure all faxes and other communications between the RC, the lead node, and the data management centers adhere to federal regulations

  • Maintain full knowledge of HIPAA regulations

Qualifications:

Required qualifications:

  • 3 year customer service & clerical experience in medical facility

  • Demonstrated understanding of insurance plans, products, referral/authorization requirements, medical records, medical terminology and procedure/diagnostic coding

  • Excellent telephone, customer service and communication skills

  • Computer experience with the ability to type 40 wpm and understand MS Outlook, Word and Excel

  • Ability to physically perform the essential functions of the position

  • Demonstrated understanding of insurance plans, products, referral/authorization requirements, medical records, medical terminology and procedure/diagnostic coding

Preferred qualifications:

  • Medical billing & coding experience

  • Knowledge of Epic computer system

About the hospital you will serve:

Providence Saint John’s Health Center in Santa Monica, California, is part of Providence Health & Services, an integrated, not-for-profit network of hospitals, care centers, medical clinics, home health services, affiliated services and educational facilities in the western United States. Founded in 1942, Providence Saint John’s Health Center enjoys a reputation for clinical excellence across many disciplines. The 266-bed health center has a medical staff of more than 900 physicians, 1,800 employees and a host of volunteers who share a commitment to providing quality care for all.

We offer comprehensive, best-in-class benefits to our caregivers. For more information, visit

https://www.providenceiscalling.jobs/rewards-benefits/

Our Mission

As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.

About Us

Providence is a comprehensive not-for-profit network of hospitals, care centers, health plans, physicians, clinics, home health care and services continuing a more than 100-year tradition of serving the poor and vulnerable. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.

Schedule: Full-time

Shift: Day

Job Category: Patient Services

Location: California-Santa Monica

Req ID: 310389

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