Referral Coordinator - Full Time, Days (Orange, Ca)

We are hospitals and affiliated medical groups, working closely together for the benefit of every person who comes to us for care. We build comprehensive networks of quality healthcare services that are designed to offer our patients highly coordinated, personalized care and help them live healthier lives. Through collaboration, we strive to provide all of our patients and medical group members with the quality, affordable healthcare they need and deserve.

The Referral Coordinator prepares referrals and address stat line requests. Complete daily tasks/queues as assigned. Assist the Referral Nurse and Medical Directors daily with additional information needed for completion. Document pertinent information in Aerial Comments and IDX referral system. Special projects as assigned.
Job Responsibilities/Duties

• Process referral requests received and assigned referral queue using Auto Approval List. Pend nurse and Medical Director review to appropriate referral requests timely to ensure compliance is maintained. Complete daily referral assignments received by fax, phone or portal etc.
• Documents all pertinent information in IDX to include medical notes, benefit information, contracted vs non contracted provider. Accurate data entry into IDX fields.
• Maintain timeliness standards by regulatory requirement for each product line.
• Maintain daily production standard based on corresponding assigned job duties set by department manager.
• Handle stat calls for assigned team on a daily basis and adhere to department standards for coverage.
• Answers all voice mail at least every hour and respond to messages within 24 hours to ensure customer satisfaction is maintained.
• Alert Nurse Reviewer of expedited requests.
• Provide notifications to providers and members within 24-72 hours or by regulatory requirements.
• Assist providers, patients and internal and external customers regarding issues related to referrals.
• Special projects as assigned which may include CCS, OIG, Unused/Expired, Fax Failure, IHA, NOMNC etc.
• Perform any additional duties that may not be inclusive in job description as requested by Management team that is within the scope of knowledge or ability of the Referral Coordinator.

Qualifications
Minimum Education: High School Diploma required.

Minimum Experience: Minimum of two (2) years of experience with Referral Healthplan, IPA or Medical Provider office with referral management and/or call center knowledge.

Req. Certification/Licensure: Certified Medical Assistant preferred.
Employee Value Proposition
Prospect Medical Holdings, Inc., is guided by a diverse and highly experienced leadership core. This group maintains the vision that has made Prospect a needed difference-maker in the lives of so many patients today, and many executives contribute to our continued efforts. As a member of our highly effective team of professionals, benefit eligible positions will receive:

• Company 401K
• Medical, dental, vision insurance
• Paid time-off
• Life insurance

How to Apply
To apply for this role, or search our other openings, please visit http://pmh.com/careers/ and click on a location to begin your journey to a new career with us!

We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources.

EEOC is the Law: https://www.eeoc.gov/

Job Type: Full-time

Pay: $18.90 - $24.25 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Retirement plan
• Tuition reimbursement
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Experience:

• Insurance verification: 2 years (Required)
• DME and home health referrals: 1 year (Required)
• HMO Medical Group Vendor: 1 year (Preferred)

Work Location: Remote

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