Referral Coordinator (Templeton, CA)

Bakersfield Family Medical Group; Templeton (CA); On-site; USD 33,434 - 39,330; Full time

Job summary

Bakersfield Family Medical Group is seeking a Referral Coordinator responsible for verifying and interpreting member benefits for health plans. The role involves interacting with other departments and providers in a friendly and professional manner to ensure a positive experience for customers.

Candidates must have a high school diploma or GED, prior experience in a medical office, and knowledge of medical terminology. This position offers an hourly pay range of $24.27 to $28.55 based on skills and experience.

Qualifications

• Minimum one year experience in a medical office environment (IPA or HMO preferred).
• Knowledge of HCPC, CPT, and ICD-10 required.
• Demonstrate good judgment and resourcefulness in problem-solving.

Responsibilities

• Verify eligibility and benefits for health plans.
• Interact with providers regarding specialist questions.
• Process referrals and ensure compliance with timelines.

Skills

Medical Terminology

Written and Oral Communication

Proficiency in Computer Systems

Organizational Skills

Problem Solving

Education

High School graduate or GED certification

Job description

Position Overview

Under the direction of the Clinic Supervisor, this position is responsible for verifying and interpreting member benefits for the health plans. The Referral Coordinator will interact with other departments, clinic personnel, and outside providers in a professional and friendly manner to create and maintain a positive relationship with internal and external customers.

Responsibilities

1. To be efficient in use of UM prior authorization systems utilized.
2. Verify eligibility and benefit interpretation via health plan and Medicare (CMS) websites.
3. Be a resource for providers regarding questions about network specialists.
4. Prepare authorizations and refer to appropriate providers/facilities and durable medical equipment (DME) companies.
5. Guide and communicate with physician office, processing staff and other departments as needed to ensure collaboration and open discussion regarding all aspects of the referral process, including responding to messages within the next business day.
6. Review accuracy of pending referrals for ICD-10, CPT, HCPC code and provider selections made by the Authorization Clerk staff.
7. Ensure referral data entry is accurately inputted into UM systems based on the referral and clinical information submitted.
8. Have a complete understanding of established policy and procedure within the provider network regarding the authorization processes.
9. Maintain assigned duties in an acceptable manner.
10. Inform management daily when problems arise or when work falls behind.
11. Compile and document good faith attempts in obtaining medical records for each pending referral when there is a lack of information.
12. Compile clinical based guidelines, criteria and/or benefit information prior to forwarding referral to UM Managers for clinical review.
13. Maintain filing in a timely manner.
14. Provide Referral Coordinator coverage as needed.
15. Process referral published on daily trending reports to maintain compliance with health plans and CMS timeframe regulations.
16. Follow and have a complete understanding of the health plan and CMS regulations regarding timelines, standards, benefit, and guideline hierarchy.
17. Adaptable to regulation and necessary departmental procedure changes that affect UM prior authorization processes.
18. Compliance with HIPM regulations and maintain patient confidentiality.
19. Cultural and Linguistics training required annually.
20. Perform other duties as assigned.

Qualifications

1. High School graduate or GED certification required.
2. One-year minimum experience working in a medical office environment (IPA or HMO preferred) with prior authorizations required.
3. Knowledge of medical terminology required.
4. Knowledge of HCPC, CPT and ICD-10 required.
5. Proficient written and oral communication skills.
6. Demonstrate proficiency in computer systems utilized.
7. Ability to remain organized and manage competing priorities.
8. Demonstrate good judgment.
9. Demonstrate ability to take and follow through with delegated tasks and accountability.
10. Demonstrate resourcefulness in problem-solving.

Compensation

The pay range for this position at commencement of employment is reasonably between $24.27 and $28.55 per hour; however, base pay may vary depending on market location, job-related knowledge, skills, and experience.

Employment Conditions

Employees are in an at-will position. The Company reserves the right to modify base salary and any other discretionary payment or compensation program at any time.

Equal Opportunity Employer

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled