An Eligibility Specialist provides assistance and information for people who apply for a government benefits program or health care program. Answers questions, assists with an application process, and reviews applications and relevant background information to determine eligibility. May assist eligible applicants with enrolling in a program.
SACRAMENTO NATIVE AMERICAN HEALTH CENTER INC - 2.9
Sacramento, CA Job Details $22 - $24 an hour 9 hours ago Qualifications Computer operation Writing skills High school diploma or GED Full Job Description Here at SNAHC, you are joining a team and company at a time of growth and transformation. You will love being surrounded by people who are as passionate as you are about healthcare and giving back to the community. Please note that individual total compensation for this position will be determined at the Company's sole discretion and the wage range for this role considers a wide range of factors including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs. At SNAHC, it is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current range is $22.00/HR-$24.00/HR.
Position Summary:
The Referral Coordinator (REFC) reports to the Referrals Manager and provides clerical and administrative support to the health center for the organization of internal and external referrals. This position will support the daily needs of all of the Referral Coordination for the medical department in the health center. The REFC is responsible for ensuring that all appointments, required documentation, insurance information and prior authorizations are established with specialty providers, insurance entities and patients. Role may need to float to other SNAHC locations
Essential Functions:
Receives referral requests from providers and communicates with them, or a member of the patient's care team, as needed Obtains prior authorizations for patient referrals to specialists and surgeries. Advises provider if authorization request is denied. Communicates with different insurance companies to process referrals appropriately and verifies eligibility of insurance for patients Requests appointments from appropriate specialty providers Verifies eligibility of insurance for patients Communicates with patients and informs them of referral status Requests consult notes once patient has been seen by specialist and closes referrals upon receipt. Communicates with Specialist regarding referral needs. Follows up on referrals with specialty providers and patients. Obtains ongoing knowledge, documentation, and updates of appropriate referral resources, required forms and key contact persons Reviews and assesses medical records for referral processing. Tracks and processes referral using NextGen Diagnostics and Referrals sections in the A/P section of the SOAP note. Prioritizes and processes referrals by urgency or PCP request. Completes referral data tracking for Quality Assurance programs. Complies with all state and federal laws and regulations, as they pertain to position including; HIPAA, sexual harassment, Scope of Practice, OSHA etc. Other duties as assigned.
Skills and Abilities:
Excellent computer skills, preferably with Windows, including Microsoft Office Suite Excellent telephone and communication skills Must possess excellent organizational, writing, and verbal skills. Ability to work independently, set priorities, and work well under pressure. Ability to maintain a high degree of confidentiality
Competencies:
Attention to
Detail Customer Service Insurance Verification Record Maintenance Research Minimum Qualifications:
High School diploma or equivalent. Minimum of 1 year of experience in office setting Excellent computer and technology skills. Ability to communicate orally and in writing; professional demeanor and the ability to represent SNAHC in the community.
Preferred Qualifications:
Experience with NextGen EHR/PM software. Knowledge of Medi-Cal, Medicare, and managed care plans Knowledge of medical terminology and medical procedure terminology
Please Note :
This position may be grant funded. Continued employment is contingent upon renewed or additional funding and may be discontinued at the close of the grant cycle. Grant funding for any position does not impart any contractual right, either expressed or implied, to remain in Sacramento Native American Health Center, Inc.'s employment for a specific period of time. Grant funding does not affect the Sacramento Native American Health Center, Inc.'s status as an "at will" employer.
