Outside Medical Referrals Coordinator

Kaiser Permanente; Downey (CA); On-site; USD 45,000 - 60,000; Full time

Job summary

Kaiser Permanente seeks a detail-oriented coordinator to maintain records of physician outside referrals for Health Plan members. You will verify authorizations, monitor payments, and set up reporting systems for outside referrals and related services.

You will review requests, verify eligibility, process billings, and educate hospital staff on policies and reimbursement practices. This role requires strong communication and accuracy in a Labor/Management Partnership environment.

Qualifications

• Minimum one (1) year of related work experience.
• Minimum one (1) year in medical billing, claims, and referrals.
• Minimum one (1) year experience required CPT and ICD 9/10 coding knowledge.
• Minimum one (1) year Familiar with coverages and benefits.
• Minimum one (1) year Medical terminology and knowledge of Medicare Guidelines.

Responsibilities

• Reviews physicians requests for outside medical services.
• Verifies patient eligibility and contacts both outside facility and patient regarding billing procedures and appointment scheduling.
• Reviews and processes billings received from outside medical providers.
• Verifies authorized services prescribed, determines accuracy and appropriateness of charges.
• Determines whether questionable billings received are to be considered for payment through the outside medical referral system and reroutes billings.
• Follows up on outstanding accounts.
• Sets up and maintains files on all outside referral patients.
• Sets up files on all no-bed patients and pre-scheduled surgeries, notifies patients and outside providers and processes invoices.
• Educates community hospital personnel, physicians and billing services regarding Kaiser Outside Medical referral and reimbursement policies and practices.
• Interpret SCPMG, KFH and KFHP policies and answer inquiries from Kaiser members, physicians and other involved personnel and support staff.
• Act as liaison between Regional Offices and local Outside Referral desk to coordinate and implement all Outside Medical Systems for SCPMG associated with use of non-Kaiser facilities for the purposes of: in and out patient referrals, supplemental bed and pre-scheduled surgeries.
• Provide accurate information to outside providers and members to help facilitate most appropriate route of health care.
• Interpret and implement necessary procedures regarding contractual agreements between Kaiser Permanente and Community Hospitals and physicians.
• Performs other administrative duties as required.

Skills

Medical terminology

Billing procedures

Communication skills

Interpersonal skills

Labor/Management environment

Analytical thinking

Education

High School diploma or GED

Job description

Kaiser Permanente seeks a detail-oriented coordinator to maintain records of physician outside referrals for Health Plan members. You will verify authorizations, monitor payments, and set up reporting systems for outside referrals and related services.

You will review requests, verify eligibility, process billings, and educate hospital staff on policies and reimbursement practices. This role requires strong communication and accuracy in a Labor/Management Partnership environment.