Clinica Sierra Vista currently operates comprehensive primary care community health centers in the rural and urban areas of Kern, Fresno, and Inyo Counties, located in California, encompassing several thousand square miles of farm land, desert, and mountain areas. Community health centers provide comprehensive primary and preventative health care, including medical, dental and behavioral health services, in areas where access to health care has historically been inadequate. Additionally, we operate multiple health education, prevention and case management programs providing a comprehensive array of health and human services. We serve primarily the low-income and uninsured population, including migrant farm workers, the homeless, and other special populations.
Schedule, problem solve, communicate, and coordinate referral appointments with outside specialists.
Track and enter all referral requests in the Referral Tracking System or EMR on a daily basis.
Coordinate with the HIM staff to track the status of all provider reports on patients referred to hospitals, outside clinics and Specialty Providers and follow up for reports/records not received on referred patients.
Maintain an accurate record(s) of external referral patient's appointments that are kept, failed, and current status in the Referral Tracking System or EMR; Monitor Referral Tracking System or EMR for outstanding provider reports that are (30 days or older), and follow-up with the appropriate provider.
Evaluate specialty referrals based on medical necessity and managed care rules
Produce an accurate weekly report of processed referrals (minimum of 40 new/follow ups Daily) to management following tracking and benchmark expectations reviewed upon hire.
Prepares and processes referral and pre-authorization paperwork for specialty visits, by creating a comprehensive referral packet, including demographics, eligibility verification and authorization for services, primary care provider referral, and primary care provider notes, diagnostics, or lab work pertinent to the specialty referral.
Verify insurance information for referral purposes and process insurance information for referral patients
Send correspondence via US mail with specialty office information for patient to schedule
Respond to In-house provider questions, requests and concerns regarding the status of patient referrals, care coordination or follow-up status.
Provide transportation consultation, coordination and support to clinic patients referred to specified health care facilities, (This includes clinic provided (if applicable), Insurance and Cab based support)
Answer, respond and document phone calls, requests, and questions from patients in a timely manner. Calls must be accurately managed or redirect as appropriate.
Routinely provide patients with other clinic and community-based resource materials as appropriate
Monitors electronic health record (EHR) notifications throughout the day to capture referral requests in real time
Utilizes third party payer/insurance portals; has a understanding of insurance providers, their portals and their expectations for authorization approvals
Ensures proper use of CPT and current ICD-10 codes to meet the requirements of third party payers and specialty clinics to ensure minimal delay in securing referral appointments or pre-authorizations
Utilizes EHR functions to document all pertinent information
May schedule referral appointments directly on behalf of patient
May perform referral tracking process utilizing the EHR or other established system
Organizes and prioritizes workload based on acuity
Maintains confidentiality by following all applicable HIPAA regulations
Other duties as assigned
Graduation from High School or equivalent GED.
Graduate of an accredited Medical Assistant program preferred, but not required.
Two (2) to three (3) years medical back office or administrative medical experience in a community healthcare preferred but not required.
Previous experience with specialty referrals in community health desired.
Intermediate computer skills required.
Clinica Sierra Vista