Referral Coordinator - Quality & Coordination

Job Description

Description

PeaceHealth is seeking a Referral Coordinator - Quality & Coordination for a Per Diem/Relief, 0.00 FTE, Day position. Hourly compensation is $19.85 – $32.22; hiring rate dependent on qualifications, professional experience, and/or work location.

Must be fully vaccinated or exempted for COVID-19 including 2 doses of a 2-dose series or 1 dose of a 1-dose series plus 14 days beyond the final dose prior to start date. PeaceHealth has a medical and religious exemption request process for those that are unable to receive the COVID-19 primary vaccine series due medical/religious reasons.

Spotlight on St John Medical Center: https://peacehealth.culturehq.com/story/5685

Assure that the services that are approved by private payors have been done and that we request more visits for patients as we continue through the episode of care. May also be responsible for management of referrals; working closely with team members to ensure optimum utilization and cost containment. Provides clerical support and assistance to staff.

Details of the position:

• Oversees the data entry and completion of referral forms/notifications. Obtains insurance pre-authorization for patients and reauthorization of additional treatment. Ensures insurance carrier (including Medicare) documentation requirements are met and referral support documentation is filed in patient’s medical record.
• Efficiently manages correspondence with patients, physicians, specialists, insurance companies. Documents pertinent information on referral form and/or in medical record. Ensures practitioners are following standardized guidelines as recommended by evidenced based medicine.
• Communicates with billing staff and third-party payors to assure coverage of patient care.
• Performs other duties as assigned.

What you bring:

• Two years college or accredited business school preferred.
• Medical Assistant, Licensed Practical nurse, or Registered Nurse highly desired.
• 3 years experience working in insurance in a medical related field, or other related experience

OTHER SKILLS:

• Demonstrated experience in insurance requirements for referrals and /or prior authorizations to various therapies (PT, RT, OT, ST), surgeries, procedures, diagnostic testing, and infusion. GYN procedures, testing, etc.
• Proficient with MS Office applications
• Proficient with Horizon Home Care

PHMG - PHYSICAL/COGNITIVE REQUIREMENTS:

• Work requires fairly light physical exertion from 34 to 65% of the time.
• Ability to lift objects weighing 30 lbs. or less.
• Work is performed under normal working conditions with adequate lighting and ventilation.
• Job duties frequently require intense concentration and attention to detail (34-65% of work time). 

PeaceHealth is committed to the overall wellbeing of our caregivers. The benefits included in positions less than 0.5 FTE are 403b retirement plan for caregiver contributions; wellness benefits, discount program, and expanded EAP and mental health program.

See how PeaceHealth is committed to Inclusivity, Respect for Diversity and Cultural Humility.

For full consideration of your skills and abilities, please attach a current resume with your application. EEO Affirmative Action Employer/Vets/Disabled in accordance with applicable local, state or federal laws.