Clinic Eligibility & Prior Authorization Specialist

A BIT ABOUT US We are Ridgecrest Regional Hospital, and our goal is to be the partner of choice for the healthcare needs of our community. We take a person centric focus on healthcare, and this means that every individual who steps through our doors # be they a patient, family member, or staff # is at the center of everything we do.

Our town of Ridgecrest is a family-friendly community of 30,000 in the desert of central Southern California, far from the traffic and commotion of LA. It#s near the Sierra Mountains and full of natural wonders, outdoor activities, and sunshine.

It offers plenty of beautiful outdoor scenery and activities, as well as shorter commutes, great schools, and a more easygoing lifestyle!

This critical access hospital is close to Mount Whitney,#Sequoia National Forest#and Death Valley. It is the perfect close-knit community if you are an outdoor adventurist looking for slightly slower-paced living while also continuing to grow in your healthcare career. What#s it like to work at RRH?:#Nurses | Kern County Hospitals JOB SUMMARY:

Performs a variety of specialized medical eligibility, authorization and scheduling duties to support the care and treatment of patients in the Rural Health Clinic. Provides customer service and support for ambulatory clinics supporting the mission and goals of RRH, organizational quality and patient-centered care.

Ensures efficient and effective patient care, through joint planning and problem-solving with clinic, office, contract and volunteer staff.# Function as part of a team-based, patient-centered care clinic serving insured and uninsured children and adults with a special emphasis on care for persons who experience barriers to accessing care.# Incorporate core organizational values of quality, respect, integrity, partnership and compassion in all activities and decisions.

Comply with organizational policies, procedures, standards of care and related laws and regulations, including HIPAA and OSHA regulations. This position supports all Ambulatory clinic locations, and provides registration and front desk coverage and special project support, across locations as needed.# Provide excellent customer service to all internal and external customers, which includes team members, patients, volunteers, students, visitors, and vendors, by consistently exceeding the customer#s expectations. Protect the dignity, privacy and confidentiality of patients and their families, as well as co-workers and others.

Essential Functions:

1.# Oversees the data entry and completion of insurance pre-authorization for patients and re-authorization of additional ambulatory primary and specialty care clinic and outpatient ancillary services.# 2.# Ensures health plan requirements are met and documentation is filed in patient#s medical record, with status clearly reflected and communicated as per procedure. 3.# Efficiently communicate with patients, physicians, specialists, and insurance companies. Documents pertinent information on patient eligibility, authorization, care gaps and services in the appropriate locations within the registration and medical record.# 4.# Works to improve eligibility and Pay for Performance (P4P) processes, communication, and patient care as it relates.

Keeps up with continual changes in the health plan program requirements, and communicates those changes as appropriate to the front office and revenue cycle teams. 5.# Proficiency with electronic HIS at Ridgecrest Regional Hospital. 7.# Must be able to put into practice Service Excellence skills with patients, families and co-workers. Qualifications: # 1.# High school graduate or equivalent, preferred. # 2.# Knowledge of office organization and basic clerical skills required, preferably obtained in an outpatient medical clinic or office. # 3.# Minimum of three years of experience working in insurance in the ambulatory medical office field or other related experience. # 4.# Must have initiative to work without constant supervision or direction. # 5.# Ability to efficiently manage time and scheduled tasks # 6.# Computer experience (Microsoft Word, Excel). # 7.# Hands Only CPR certification or will obtain within 2 months of hire.

A BIT ABOUT US

We are Ridgecrest Regional Hospital, and our goal is to be the partner of choice for the healthcare needs of our community. We take a person centric focus on healthcare, and this means that every individual who steps through our doors - be they a patient, family member, or staff - is at the center of everything we do.

Our town of Ridgecrest is a family-friendly community of 30,000 in the desert of central Southern California, far from the traffic and commotion of LA. It's near the Sierra Mountains and full of natural wonders, outdoor activities, and sunshine.

It offers plenty of beautiful outdoor scenery and activities, as well as shorter commutes, great schools, and a more easygoing lifestyle!

This critical access hospital is close to Mount Whitney, Sequoia National Forest and Death Valley. It is the perfect close-knit community if you are an outdoor adventurist looking for slightly slower-paced living while also continuing to grow in your healthcare career.

What's it like to work at RRH?: Nurses | Kern County Hospitals

JOB SUMMARY:

Performs a variety of specialized medical eligibility, authorization and scheduling duties to support the care and treatment of patients in the Rural Health Clinic. Provides customer service and support for ambulatory clinics supporting the mission and goals of RRH, organizational quality and patient-centered care.

Ensures efficient and effective patient care, through joint planning and problem-solving with clinic, office, contract and volunteer staff. Function as part of a team-based, patient-centered care clinic serving insured and uninsured children and adults with a special emphasis on care for persons who experience barriers to accessing care. Incorporate core organizational values of quality, respect, integrity, partnership and compassion in all activities and decisions.

Comply with organizational policies, procedures, standards of care and related laws and regulations, including HIPAA and OSHA regulations. This position supports all Ambulatory clinic locations, and provides registration and front desk coverage and special project support, across locations as needed. Provide excellent customer service to all internal and external customers, which includes team members, patients, volunteers, students, visitors, and vendors, by consistently exceeding the customer's expectations. Protect the dignity, privacy and confidentiality of patients and their families, as well as co-workers and others.

Essential Functions:

1.Oversees the data entry and completion of insurance pre-authorization for patients and re-authorization of additional ambulatory primary and specialty care clinic and outpatient ancillary services.

2.Ensures health plan requirements are met and documentation is filed in patient's medical record, with status clearly reflected and communicated as per procedure.

3.Efficiently communicate with patients, physicians, specialists, and insurance companies. Documents pertinent information on patient eligibility, authorization, care gaps and services in the appropriate locations within the registration and medical record.

4.Works to improve eligibility and Pay for Performance (P4P) processes, communication, and patient care as it relates.

Keeps up with continual changes in the health plan program requirements, and communicates those changes as appropriate to the front office and revenue cycle teams.

5.Proficiency with electronic HIS at Ridgecrest Regional Hospital.

7.Must be able to put into practice Service Excellence skills with patients, families and co-workers.

Qualifications:

1.High school graduate or equivalent, preferred.

2.Knowledge of office organization and basic clerical skills required, preferably obtained in an outpatient medical clinic or office.

3.Minimum of three years of experience working in insurance in the ambulatory medical office field or other related experience.

4.Must have initiative to work without constant supervision or direction.

5.Ability to efficiently manage time and scheduled tasks

6.Computer experience (Microsoft Word, Excel).

7.Hands Only CPR certification or will obtain within 2 months of hire.