Job: Referrals and Authorization Clerk Lead FT (Elm Site)

This posting has expired and is no longer available.

Job Description

  • Job Tracking ID: 512329-588346
  • Job Location: Escondido, CA
  • Job Level: Any
  • Level of Education: Any
  • Job Type: Full-Time/Regular
  • Date Updated: August 22, 2017
  • Years of Experience: Not Applicable
  • Starting Date: ASAP

Job Description:

Job Description:

Summary: Under direction of the Region Director, Lead Referrals Clerk and working closely with the providers at clinics, the Referrals & Authorization Clerk is responsible for the coordination of all patient referrals and follow-up care for the clinic patients.

Essential Duties/Responsibilities:

  1. Responsible for completing the referral process including:
    • Obtain referral from provider in timely manner
    • Obtain authorization where applicable
    • Schedule appointments
    • Communicate appointment information to patient/family
    • Communicate referral/authorization information and pertinent medical information to the specialty provider
    • Follow-up with the patient and specialty provider to document that patient has kept appointment
    • Obtain the consult/progress reports from the specialty provider, radiologist, etc.
    • Appropriate documentation in the patient medical records
  2. Track all referrals in the designated logs
  3. Document all actions taken in the patient medical record in accordance with current Clinic, DHS and Health Plan regulations/guidelines
  4. Meet or discuss with patients any and all aspects of the referral process as needed or requested by the treating provider. This may include counseling the patient regarding the cost of a referral under provider direction.
  5. Patient communication in person, by telephone and/or by mail.
  6. Maintain accurate lists of specialists/providers by funding source and other community resources as approved by the Medical Director and/or supervisor.
  7. Act as liaison between patient, clinic/providers, specialty care providers, health plans/funding sources and community resources.
  8. Assist and actively participate with the CDP Cancer Detection Program, including maintaining the CDP log and completing all follow-ups for the clinic.
  9. Maintain the CHDP log with follow-ups and applicable letters. Assure that copies of the log and applicable letters are sent to the country and state on a quarterly basis as dictated by CHDP.
  10. Attend Health Plan Case Management operation meetings and MSO UM meetings on a rotating basis.
  11. Assist and actively participate with the CDP Cancer Detection Program, including maintaining the CDP log and completing all follow-ups for the clinic.
  12. Coordinates the scheduling of the Referral clerks and pre-approves the time off.
  13. Monitoring the daily assignments for completeness of task.
  14. Responsible for training new Case Management employees. Assigns new hire to another Referrals clerk if unable to directly train the individual. Assures that new hires have an opportunity to experience those tasks identified on the skills check off list.
  15. Provides input into the evaluations of the Referral clerks.
  16. Attend Case Management Referral Task Force meetings as directed.
  17. Function at highest level according to credentials and competency
  18. Positively impact patient experience by demonstrating values of Transforming Care including, but not limited to, courteous and helpful behavior and a commitment to accuracy
  19. Share accountability for overall patient health outcomes, working in coordination with Care Teams
  20. Operate to instill confidence in our care and in our facilities to patients, fellow employees, and other stakeholders
  21. Other duties as assigned.

Experience and Skills:

Experience and Skills:

Qualifications & Skills: Strong interpersonal relationship skills and ability to lead others. Knowledge of payers and authorization process. Knowledge of ICD-10 terminology. Strong written and verbal skills. Strong organizational skills. The ability to work on multiple tasks and be versatile. Excellent computer skills ie.. scanning, PDF files, database maintenance. Knowledge of Microsoft Office programs and EMR systems. Bilingual English/Spanish is required.

Education & Experience: Experience in training new staff members. Experience in preparing and conducting meetings and training's preferred. Strong emotional intelligence. 6 months previous Lead experience preferred.

Locations

Date Clinic
425 N. Date Street
Escondido, CA 92025
Date Dental Clinic
425 North Date Street
Escondido, CA 92025
El Cajon
855 E. Madison Ave.
El Cajon, CA 92020
Elm Clinic
460 N. Elm St.
Escondido, CA 92025
Grand Clinic
1001 E. Grand Ave
Escondido, CA 92025
Hemet, CA
-
Hemet, CA 92544
Ivy
401 E. Valley Pkwy.
Escondido, CA 92025
Lakeside Clinic
10039 Vine St.
Lakeside, CA 92040
MHS
Misson Avenue
Escondido, CA 92025
Palomar Medical Center - Hospitalist
425 N. Date
Escondido, CA 92025
Pauma Valley Clinic
16650 Highway 76, PO Box 655
Pauma Valley, CA 92061
Pediatrics & Prenatal Clinic
426 N Date St.
Escondido, CA 92025
Sun City
26926-B Cherry Hills Blvd.
Menifee, CA 92584
Temecula
41715 Winchester Rd., Suite 106
Temecula, CA 92590
Valley Parkway Clinic
728 East Valley Parkway
Escondido, CA 92025
Not Specified
-
Not Specified, NS 99997
Date Clinic
Date Dental Clinic
El Cajon
Elm Clinic
Grand Clinic
Hemet, CA
Ivy
Lakeside Clinic
MHS
Palomar Medical Center - Hospitalist
Pauma Valley Clinic
Pediatrics & Prenatal Clinic
Sun City
Temecula
Valley Parkway Clinic
Not Specified

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