Medical Referral Clerk (Winnetka)

El Proyecto Del Barrio; Los Angeles (CA); On-site; USD 30,000 - 37,000; Full time

Job summary

El Proyecto Del Barrio is seeking a Referral Coordinator at the Winnetka Health Clinic in Winnetka, CA. This full-time role will coordinate patient referrals, process HMOs, Medi-Cal, Medicare, and MHLA referrals, and ensure timely submission of required reports.

The ideal candidate has a high school diploma, 1–2 years of related experience, strong organizational skills, and proficiency with Microsoft Office.

Qualifications

• Knowledge of medical referral processes and procedures.
• Knowledge of CPT codes and ICD10.
• High level of professionalism, customer service, and interpersonal skills.
• Ability to be well-organized and precise.
• Strong computer skills in Microsoft Office.
• Ability to communicate in an articulate, professional manner while maintaining confidentiality.
• Ability to work independently, meet deadlines, and multi-task while maintaining quality standards.

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 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.
• Perform other duties as assigned.

Skills

Medical referrals

CPT/ICD10 knowledge

Organized

Customer service

Microsoft Office

Confidentiality

Independent work

Multitasking

Communication skills

Education

High school diploma or equivalent

1–2 years related experience

Job description

Job Details

Job Location: Winnetka Health Clinic - Winnetka, CA 91306

Position Type: Full Time

Salary Range: $22.71 - $27.25 Hourly

Must feel comfortable working in a fast-paced environment.

Bilingual in English and Spanish preferred.

Must feel comfortable working with underserved communities.

Able to adapt to evolving operational needs highly preferred.

Previous experience submitting and obtaining referrals preferred.

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.

QualificationsKNOWLEDGE / 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.
• Strong computer skills in Microsoft Office.
• 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.
• Bilingual (English/Spanish) preferred.
• 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 -