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 an 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 & Health Information Specialist
Summary: The Referrals & Health Information Specialist is responsible for providing excellent patient care, customer service, preparation, filing and maintenance of all medical records and/or by ensuring that a patient's insurance allows them to access specialty services via coordination, processing, and completing of all internal and external specialty clinic referrals authorizations within expected timeframe for Petaluma Health Center.
Areas of Responsibility:
- Verification of patient insurance eligibility.
- Maintains updated authorizations/referrals information in patient chart through a tracking mechanism
- Provides assistance to uninsured patients to be enrolled in PAP program
- Provides information to patient through warm hand offs as needed
- Assist with patient requests for medical records within one week
- Prepare, fax and / or mail Health Information Release requests within five days
- Close open referrals when consult notes are received. Follow up on pending and outside referrals daily
- Assist providers and staff on urgent requests
- Complete telephone encounters received from providers, staff and patients daily
- Check providers’ schedules each morning for any added appointments
- Chart prep for the following day prior to end of shift
- Assist with phone messages and faxed requests as needed daily, makes and/or answers phone calls regarding any referral questions
- Assist patients in the appeals process for denial of services through the proper appeals process with their insurance companies
- Maintain extensive resource directory for PHC staff and patients for access of community resources
- Process all outside referrals from other PCP/specialist within expected timeframe
- Closes 20 referrals daily
- Tracks the completion of the referral process within expected timeframe
- Track referrals by using structured data to maintain up to date accurate information
- Ensures follow up with Public Health Nurse for CHDP Referrals made
- 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 Referrals and Specialty Clinics Operations Manager or Team Manager