Patient Services Coordinator-Provider Relations (Authorization & Insurance)

County of Riverside; Riverside (CA); Remote; USD 45,000 - 60,000; Full time

Job summary

The County of Riverside is seeking a Patient Services Coordinator to manage patient referrals and authorizations within the Riverside University Health System. The ideal candidate will have experience in medical insurance processes, strong customer service skills, and the ability to work independently in a fast-paced environment. This role involves coordinating with healthcare providers and ensuring compliance with medical regulations.

Qualifications

• At least three years of clerical experience, including one year in managed care or healthcare.
• Experience as a Licensed Vocational Nurse or equivalent is preferred.

Responsibilities

• Coordinate referrals and obtain authorizations for patient care.
• Handle daily intake and outbound calls, verifying member eligibility.
• Liaise between healthcare staff and patients regarding care maintenance.

Skills

Customer Service

Communication

Medical Terminology

Confidentiality Rules

Education

High School Diploma or GED

Job description

The County of Riverside - Riverside University Health System (RUHS) - Provider Relations Department is seeking a detail-oriented and experienced Patient Services Coordinator with a strong background in medical insurance and prior authorization processes. The ideal candidate will have hands-on experience verifying patient benefits, obtaining prior authorizations for medical procedures or medications, and working directly with insurance providers to ensure timely and accurate approvals.

Under minimal supervision, performs a variety of administrative and clerical duties in support of the Riverside University Health System (RUHS) Managed Care or Care Management program, secures authorization for services, completes patient assessments for eligibility criteria; and performs other related duties as required.

The Patient Services Coordinator will primarily coordinate referrals generated with contracted Managed Care Plans, both public and private. Additionally, this role involves coordination with physicians and mid-level providers regarding patient care or IPA's for all scheduled patients at RUHS, and obtaining necessary authorizations for patient care.

Main duties include but are not limited to:

1. Submitting and obtaining authorization services such as clinic visits, specialty visits, outpatient surgeries, and eConsults.
2. Liaising between healthcare staff and patients regarding maintenance of care and treatment.
3. Handling daily intake and outbound calls to input data into EMR and verify member eligibility.
4. Providing customer service and tracking pending referrals.
5. Ensuring the validity of CPT and ICD-10 codes.
6. Submitting and obtaining authorization from payers.
7. Running eligibility checks.
8. Managing ED and inpatient discharges.
9. Procurement of authorizations.
10. Handling incoming and outbound calls.

Preferred experience includes:

• Authorization, insurance, and eligibility experience.
• Strong customer service skills.
• Clinical background.

Work Schedule:

To be discussed during the interview. Tentative: 5/40, Mon.-Fri, 8 am - 4:30 pm.

Work Location:

Mission Grove (7888 Mission Grove Pkwy, Riverside, CA 92508), Telecommuting position.

Meet the Team!

Riverside University Health System involves assisting physicians and healthcare providers by providing care coordination to ensure patients receive optimal care. The role includes interaction with Primary Care Providers, Specialty Providers, and other healthcare staff to coordinate care, facilitate communication, and manage referrals and patient education.

Additional responsibilities include managing referrals, authorizing Treatment Authorization Requests (TAR), coordinating with contracted IPAs, transferring patients, verifying eligibility, and processing third-party claims.

Education:

Graduation from high school or possession of a Certificate of Proficiency issued by the California State Board of Education, or a satisfactory G.E.D. score.

Experience:

At least three years of broad clerical experience, including at least one year in a managed care, healthcare, or behavioral health setting. Experience as a Licensed Vocational Nurse or equivalent is preferred.

Knowledge of:

• Confidentiality rules regarding medical information.
• Medical terminology and healthcare regulations.
• Healthcare compliance laws.

Abilities:

• Interpret medical information and apply guidelines.
• Communicate effectively both orally and in writing.
• Maintain effective relationships with diverse individuals.
• Work independently and as part of a team.
• Operate communication systems and information processing equipment.
• Utilize motivational interviewing skills.
• Work efficiently in a fast-paced environment and provide excellent customer service.

For additional information or questions, contact Anay Sanchez at [e-mail] or 951-955-5893.