Medical Referral Clerk (Winnetka)

El Proyecto del Barrio, Inc.; California; In loco; USD 30.376 - 36.451; Tempo pieno

Vantaggi offerti da questo lavoro

Mileage reimbursement

BLS/CPR certification preferred

Descrizione del lavoro

El Proyecto del Barrio, Inc. in California is seeking a Full Time position focused on coordinating patient referrals. This role involves processing various forms of healthcare referrals, liaising between patients, providers, and health plans while maintaining necessary logs and reports.

The ideal candidate should have a high school diploma or equivalent and 1 to 2 years of relevant experience, with knowledge of medical referral processes and terminologies. A strong customer service orientation and professionalism are important for success in this role.

Competenze

• High school diploma or equivalent or a combination of education and related work experience.
• 1 to 2 years of related experience.

Mansioni

• Process referral requests, verifying insurance eligibility.
• Maintain logs to track prospective, retrospective, and denials.
• Coordinate with the Claims Adjudicator and Case Managers about patient referrals.

Conoscenze

Knowledge of medical referral processes

Customer service skills

Interpersonal skills

Knowledge of medical terminology

Ability to communicate professionally

Formazione

High school diploma or equivalent

Descrizione del lavoro

Overview

Salary Range

$22.05 - $26.46 Hourly

Position Type

Full Time

Description

JOB SUMMARY

This position will coordinate patient referrals between healthcare providers. This position will also process HMOs, Medi-Cal, Medicare, and MHLA referrals.

ESSENTIAL RESPONSIBILITIES

• Process referral requests, verifying insurance eligibility.
• Obtain necessary authorizations and enter data to generate authorization numbers.
• Present prospective and retrospective referrals to the UR meeting.
• Maintain logs to track prospective, retrospective, and denials.
• Submit required UM reports to the health plans in a timely fashion.
• Coordinate with the Claims Adjudicator and Case Managers about patient referrals, claims, and case management.
• Liaise among patients, Managed Care Department, providers, specialists, hospitals, and health plans on referrals.
• Assist providers and specialists with the referral process.
• Participate in the preparation of funding audits.
• Generate and review patient referral utilization reports.
• Facilitate scheduling of appointments with referred healthcare providers.
• Perform other duties as assigned.

Qualifications

KNOWLEDGE / SKILLS / ABILITIES

• Knowledge of medical referral processes and procedures.
• Knowledge of basic medical terminology, CPT codes, and ICD10.
• Ability to be well-organized and precise.
• High level of professionalism, customer service, and interpersonal skills.
• Ability to communicate in an articulate, professional manner while maintaining a necessary degree of confidentiality.
• Ability to work independently, meet deadlines, and multi-task while maintaining quality standards.
• Ability to pleasantly and effectively represent the organization.

EDUCATION / EXPERIENCE

• High school diploma or equivalent OR a combination of education and related work experience.
• 1 to 2 years of related experience.

CERTIFICATIONS / LICENSURE / LANGUAGE

• Must provide proof of required vaccinations by federal, state, and local funding sources.
• BLS/CPR certification preferred.
• Employees driving personal vehicles for El Proyecto business must provide El Proyecto proof of a valid driving license, and auto liability insurance.
• El Proyecto will reimburse employees for their mileage at the current rate set by the Internal Revenue Service. To receive mileage reimbursement, the employee must log their mileage and submit the mileage expense report to their Appropriate Administrator.

PHYSICAL REQUIREMENTS

• Walking, talking, sitting, bending, stooping, and lifting up to 10 pounds; hand and wrist dexterity to utilize a computer.

- AN EQUAL OPPORTUNITY AND AFFIRMATIVE ACTION EMPLOYER -