Clinicas Del Camino Real, Inc. has been providing quality primary and preventative health care services to the residents of Ventura County since 1971. We have an exciting opportunity for a Referral Coordinator, to work in our Referrals department in Camarillo, CA
The Referral Coordinator is essential in obtaining medically appropriate services inside and outside of Clinicas del Camino Real, Inc. Patient needs, including referral to a Specialist, are identified by the Clinicas practitioner and processes through an established referral system. The Referral Coordinator expedites the administrative requirements for patient referrals, ensuring that appropriate referrals are made to participating providers within the patient’s health plan.
- Obtains appointments for Specialist visits and notifies patients of appointments.
- Acts as a resource regarding referrals and insurance plan guidelines. • Interprets medical guidelines, benefits, policies and procedures in support of their objective to expedite the referral process.
- Knowledgeable about the regulations of various payer sources including, but not limited to: Self Pay, Private Insurance, Medi-Cal, Medicare, Medi-Cal & Insurance Managed Care/HMO, Children’s Health and Disability Prevention (CHDP), Healthy Families, Family PACT, and California Children’s Services (CCS). Knowledgeable about the regulations regarding these various payer sources.
- Manages member/patient and provider inquiries regarding referral status, the authorization process and other issues in a courteous and professional manner.
- Data entry of authorization into Electronic Health Records and /or Utilization Review system, ensuring that all referrals are tracked through to a completed visit and a report is received.
- Collaborates with Providers, Health Center Nurses/Medical Assistants, and UM Nurses to obtain additional medical information and notifies UM Nurse of potentially urgent requests.
- Processes all referral requests according to Clinicas’ policies and procedures.
- Verifies member eligibility via insurance carrier and/or Medi-Cal web portal
- Participates in the introduction and implementation of new procedures.
- Makes recommendations regarding changes, improvements, or enhancements to appropriate staff.
- Assists with training and orienting new employees, as assigned.
- Coordinates and assists with obtaining surgery appointments and re-scheduling missed appointments as needed.
- Notifies patients of authorization status, as needed.
- Distributes denial letters to appropriate recipients.
- Attends meetings as assigned.
- Provides excellent customer service to patients, vendors and employees.
- May assist patients with mental illness, substance abuse problems and or/emotional disturbance.
- Due to the nature of the job, may work with or be exposed to information or material of a sexual nature.
- Performs other duties as assigned including participation in all safety programs which may include assignment to an emergency response team.
High school diploma or GED required; AS degree and/or Medical Assistant Certificate or Medical Billing Certificate preferred. Cognitive Skills (Language, Math and Reasoning Ability): High reasoning, high language skills including medical terminology, critical thinking and critical problem solving skills required. Bilingual English/Spanish speaking and writing is required. Ability to work in a team environment is required. Excellent organizational skills are required. Prefer 2 years’ work experience in a medical environment (IPA or HMO preferred), with pre-authorizations and reimbursement. Familiar with regulations pertaining to various payer sources. Computer Skills: Ability to effectively use Word, Excel, access specific sites on the internet, document within electronic health records and/or authorization system with minimal typing/spelling errors, send e-faxes and email. Ability to work with a diverse group of people; handle multiple issues that are time sensitive and to ask appropriate questions. Must have reliable transportation to work.