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JOB TITLE: Certified Medical Assistant/Prior Authorization/Referral Coordinator
REPORTS TO: RH Clinic Supervisor
DEPARTMENT: Medical
LOCATION: Rolling Hills Clinic (RHC)
740 Solano Street, Corning, CA 96021
2540 Sister Mary Columba Drive, Red Bluff, CA 96080
STATUS: Full-time, 100% FTE, Non-ExemptNative Preference in hiring is given to qualified enrolled members of Paskenta Band of Nomlaki Indians and Native Americans in accordance with the Indian Preference Act (Title 25, US Code, Section 472 and 473). Applicants claiming Indian Preference must submit verification of Indian certified by tribe of affiliation or other acceptable documentation of Indian heritage.
POSITION SUMMARY
The Certified Medical Assistant/Prior Authorization/Referral Coordinator primary job function is coordinating transition services with internal and external partners to ensure the accuracy and completeness of all required documentation is of the highest quality while providing exceptional customer service. The employee will promptly, efficiently and accurately execute all aspects of the prior authorization and referral process in accordance with regulatory requirements in a timely manner and keep patient and provider informed when there are delays or denials from insurance or by provider referred to communicate all resolutions if appropriate.
Excellent communication and legible writing skills are required to ensure proper data entry and there are no miscommunications with patients, internal and external partners. The Referral Coordinators are responsible for building strong, positive relationships with patients and other health care facilities. This position requires processing and completing an average of 15-30 prior authorizations and referrals daily.
ESSENTIAL JOB FUNCTIONS
1. Understand and execute the principles of Prior Authorization to facilitate the right care at the right time in the right setting.
2. Able to solve complex prior authorization questions and issues.
3. Effectively handle all incoming provider calls including the most challenging provider offices.
4. Ensures quality and accuracy of the patient insurance information and that listed certification periods, billing addresses, policy numbers, authorization numbers, etc. are all entered correctly.
5. Prioritizes and processes incoming Insurance Verifications and Prior Authorization requests.
6. Verify the patients private/commercial/managed health care insurance via telephone, or online systems.
7. Obtain authorization from patients private/commercial or managed health care insurance and all other payor sources requiring authorization via telephone, facsimile, or online systems while maintaining compliance to medical record confidentiality regulations.
8. Maintains authorizations extension for all patients as appropriate and notifying in-house medical assistants if there are any changes immediately (documenting the notification).
9. Refers authorization requests that require clinical judgment to Prior Authorization Supervisor and clinical support staff.
10. Obtain information from agencies when necessary to assist with receiving authorizations and re-authorizations from private insurance and all other payor sources.
11. Assist other departments and Care Centers in the efficient collection of client and payor information to ensure accuracy.
12. Enter all hospice benefit information into Registration Tool and patient accounting system.
13. Respond to calls, emails and other inquiries regarding the status of outstanding referrals and/or authorization information in a timely manner.
14. Provides other administrative support to the department as needed.
15. Complete payer Information Form (PIF), and Payor Change Request Forms (PCR) or Patient Referral in-house Coordinator for Tribal members (PRC) when needed for the purpose of meeting payer and client's needs to ensure accurate reimbursement.
16. Update Contracting Coordinator of payer information changes.
17. Coordinates with members, providers and key departments to promote an understanding of Prior Authorization, Referral, and Insurance Verification requirements and processes.
18. Communicate efficiently, effectively, and timely to resolve issues pertaining to the verification and authorization processes.
19. Access Medicare's Common Working File (CWF) to verify eligibility in the event a patient has termed coverage with private insurance carrier if applicable.
20. Employee Safety: Safely performs all duties; follows required protective protocols to ensure personal safety as well the safety of others.
21. Must maintain compliance with ergonomic safety standards; be mindful of posture and regularly practice ergonomic stretches.
22. Safety: Responsible for ensuring that all duties, responsibilities and operations are performed with the utmost regard for the safety and health of all personnel involved, including themselves.
23. Safety: Take appropriate corrective actions to address matters pertaining to employee health and safety that have been brought to their attention.
24. Other duties as assigned.
MINIMUM REQUIRED QUALIFICATIONS
1. Must have a High school diploma or equivalent.
2. Associate's degree or equivalent from two-year college or technical school.
3. Three (3) years of progressive finance and accounting experience or a combination of education and/or experience
4. Must have knowledge of financials, account analysis and reconciliation, general ledger and daily journal entries.
5. Must be able to demonstrate experience in accounts payable, accounts receivable, cash and revenue functions.
6. Must have strong organizational and multi-tasking skills.
7. Must be able to work well with others or alone, under minimal supervision.
8. Must be able to work well under pressure and strict deadlines.
9. Strong computer experience required. 10-key by touch. Typing ability of 50 wpm
10. Governmental accounting preferred.
Vacancy expired!