Medical Referrals Specialist

    • Job Tracking ID: 512365-598033
    • Job Location: Petaluma, CA
    • Job Level: Entry Level (less than 2 years)
    • Level of Education: High School/GED
    • Job Type: Full-Time/Regular
    • Date Updated: February 16, 2018
    • Years of Experience: Up to 2 Years
    • Starting Date: ASAP
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Job Description:

The Petaluma Health Center’s mission is to provide high quality health care, with access for all, in Southern Sonoma County. The Center accomplishes this mission through collaborative, innovative programs, services and referral resources that meet the economic needs of the entire community.

The Petaluma Health Center is a eight-time award winner in the North Bay Business Journal’s Best Places to Work for 2017, 2016, 2015, 2014, 2013, 2012, 2011 and 2009 and we were named as one of '2015 Healthiest Companies in the North Bay' by the North Bay Business Journal.

We are a Federally Qualified Health Center (FQHC) that provides primary medical care and mental health services to residents of Petaluma, Rohnert Park, Cotati, Penngrove and surrounding areas. We are organized as a private, non-profit corporation and governed by a consumer and community led Board of Directors.

For more information about us, please visit us at www.phealthcenter.org.

 

Position Title: Referrals Specialist

 

Summary: The Referrals Specialist coordinates all referrals to outside providers at the direction of all providers.

 

Areas of Responsibility:

  • Responsible for completion and processing of all authorizations and referrals ordered by providers and requested by patients for services outside of PHC
  • Verification of patient insurance eligibility
  • Maintain authorizations/referral information in patient chart through a tracking mechanism
  • Assist patients in the appeal process for denial of services through the proper appeals process with their insurance companies
  • Tracks the completion of the referral process
  • Maintain extensive resource directory for PHC staff and patients for access of community resources
  • Knowledge of managed care requirements for referrals
  • Participates in MAA Coordination and Claims Administration, including but not limited to completion of the annual time survey
  • Perform other duties as assigned by Team Manager and Director of Clinical Operations

 

Experience and Skills:

Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.

 

Education/Experience

  • High school diploma or equivalent
  • Medical office training
  • Minimum one year experience with insurance, referrals, authorizations, and community contacts preferred

 

Desired Skills:

  • Ability to effectively present information and respond to questions from groups of patients, physicians and other medical personnel concerning referral resources for various payers
  • Excellent organizational skills with attention to detail, multi-tasking and the ability to prioritize tasks and needs of patients and providers
  • Ability to communicate, both written and verbal
  • An energetic and creative individual with high standards and an appropriate professional image
  • Proven ability to handle multiple projects and meet deadlines
  • Versatility, flexibility and willingness to work within an ambiguous, fast-paced environment
  • Demonstrated resourcefulness in providing solutions and setting priorities
  • Effective interpersonal skills to work effectively with all levels within the health center

 

Language Skills: Ability to communicate effectively in English and Spanish with children and adults in person, on the telephone, and in writing. Ability to effectively present information and respond to questions and requests from patients, co-workers and others as necessary.

 

Petaluma Health Center is an equal opportunity employer.

 

Please apply directly through our career page at www.phealthcenter.org.