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Referrals and Authorizations Clerk

2 months ago

Escondido, United States Neighborhood Healthcare Full time
Job DescriptionJob Description

Community health is about more than just vaccines and checkups. It’s about giving people the resources they need to live their best lives. At Neighborhood, this is our vision: a community where everyone is healthy and happy. We’re with you every step of the way, with the care you need for each of life’s chapters. At Neighborhood, we are Better Together.

As a private, non-profit 501(C) (3) community health organization, we serve over 414,000 medical, dental, and behavioral health visits from more than 95,000 people annually. We do this in pursuit of our mission to improve the health and happiness of the communities we serve by providing quality care to all, regardless of situation or circumstance.

Since 1969, our employees have been making this mission a reality. Regardless of the role, our team focuses on being compassionate, having integrity, being professional, always collaborating, and consistently going above and beyond. If this sounds like an organization you would like to be a part of, we would love to meet you.

Under direction of the Clinical Services Supervisor, 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.

DIRECT PATIENT CARE

  • Communicate appointment information to patient/family.
  • Follow-up with the patient and specialty provider to document that patient has kept their appointment.
  • 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.
  • Patient communication in person, by telephone via MyCare using ENC and/or by mail.
  • Act as liaison between patient, clinic/providers, specialty care providers, health plans/funding sources and community resources.
  • Positively impact patient experience by demonstrating values of Transforming Care including, but not limited to, courteous and helpful behavior and a commitment to accuracy
  • Operate to instill confidence in our care and in our facilities to patients, fellow employees, and other stakeholders

PROVIDER AND TEAM SUPPORT

  • Obtain referral from provider in timely manner.
  • Obtain authorization where applicable.
  • Assist and actively participate with the CDP Cancer Detection Program, including maintaining the CDP log and completing all follow-ups for the clinic.
  • Communicate referral/authorization information and pertinent medical information to the specialty provider.
  • Obtain the consult/progress reports from the specialty provider, radiologist, etc.
  • Appropriate documentation in the patient medical records.
  • Maintain accurate lists of specialists/providers by funding source and other community resources as approved by the Medical Director and/or supervisor.
  • Attend Health Plan Case Management operation meetings and MSO UM meetings on a rotating basis.
  • Share accountability for overall patient health outcomes, working in coordination with Care Teams

CLINICAL ADMINISTRATION

  • Track all referrals in the designated logs and/or electronically via eCW.
  • Document all actions taken in the patient medical record in accordance with current Clinic, DHS and Health Plan regulations/guidelines
  • Function at highest level according to credentials and competency
  • Schedule appointments.
  • Other duties as assigned.

QUALITY MANAGEMENT

  • Display knowledge of normal signs of human development and ability to assess and provide age appropriate care.
  • Contribute to the success of the organization by participating in quality improvement activities
Qualifications

Skills: Bilingual (English/Spanish), (English/Arabic), or (English/Mandarin) may be required (Must pass Language Proficiency Test). Excellent computer skills; scanning, spreadsheets, database maintenance. Knowledge of Microsoft Office programs. Strong communication and organizational skills. The ability to interact with a diverse population, personnel, vendors and others.

Education: High School Diploma/GED preferred.

Experience: Minimum of one-year experience working in a medical office preferred. Knowledge of ICD-10 and medical terminology.

Neighborhood Healthcare offers a generous benefit plan that includes: Medical, Dental, and Vision Plans. Two plus weeks of vacation, Nine Holidays including two Floating Holidays of your choosing, Sick/Personal time, Volunteer Time Off (VTO), 403b Retirement plan (similar to a 401k), optional Health and Wellness events, and much more

Pay Range: $21.79 to $24.21 per hour, depending on experience.