Referral Specialist

The Petaluma Health Center's mission is to provide high quality health care with access for all in Southern Sonoma County & West Marin. We pride ourselves on our Patient-Centered care while maintaining an engaging environment for our staff. The Center accomplishes this mission through collaborative, innovative programs, services and referral resources that meet the economic needs of the entire community.

FULL TIME EMPLOYEE BENEFITS:

• 21 Days of Paid Time Off
• 10 Observed Holidays
• Medical Insurance (Entire deductible paid by us!)
• 30 Chiropractor and Acupuncture visits per year included with enrollment in our health insurance plans (Kaiser and WHA)
• Dental Insurance
• Vision Insurance
• Gym Membership Discounts at Synergy Health Club and 24-Hour Fitness!
• 401K Matching after 1 year of employment
• Flexible Spending Account, Dependent Care FSA
• Life Insurance (included at no cost to the employee)
• Long Term Disability (included at no cost to the employee)
• Employee Assistance Program (included at no cost to the employee)

Summary: Entry level position responsible for providing excellent patient care and customer service 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.

Areas of Responsibility:

Patient Care

• 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.

Customer Service

• 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.

Referral Tracking

• 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 Director of Clinical Operations

Education/Experience

• High school graduate with medical office training.
• Two years experience with insurance, referrals, authorizations, and community contacts.

Desired Skills:

• 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.