The Petaluma Health Center's mission is to provide high quality health care, with access for all, in Southern Sonoma County. The Center accomplishes this mission through collaborative, innovative programs, services and referral resources that meet the economic needs of the entire community.
The Petaluma Health Center is an eight-time award winner in the North Bay Business Journal's Best Places to Work for 2017, 2016, 2015, 2014, 2013, 2012, 2011 and 2009 and we were named as one of '2015 Healthiest Companies in the North Bay' by the North Bay Business Journal.
We are a Federally Qualified Health Center (FQHC) that provides primary medical care and mental health services to residents of Petaluma, Rohnert Park, Cotati, Penngrove and surrounding areas. We are organized as a private, non-profit corporation and governed by a consumer and community led Board of Directors.
For more information about us, please visit us at www.phealthcenter.org.
Position Title: Referrals & Health Information Specialist
The Referrals & Health Information Specialist is responsible for providing excellent patient care, customer service, preparation, filing and maintenance of all medical records and/or 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 for Petaluma Health Center.
Areas of Responsibility:
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
Assist with patient requests for medical records within one week
Prepare, fax and / or mail Health Information Release requests within five days
Close open referrals when consult notes are received. Follow up on pending and outside referrals daily
Assist providers and staff on urgent requests
Complete telephone encounters received from providers, staff and patients daily
Check providers' schedules each morning for any added appointments
Chart prep for the following day prior to end of shift
Assist with phone messages and faxed requests as needed daily, 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
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 Team Manager
Experience and Skills:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.
High school graduate with medical office training
Two years experience with insurance, referrals, authorizations, and community contacts
Ability to effectively present information and respond to questions from groups of patients, physicians and other medical personnel concerning referral resources for various payers
Excellent organizational skills with attention to detail, multi-tasking and the ability to prioritize tasks and needs of patients and providers
Ability to communicate, both written and verbal
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
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.
Ability to add, subtract, multiply, divide in all units of measure, using whole numbers, common fractions and decimals.
Reasoning Ability: Ability to recognize problems, collect data, and establish facts.
Computer literate and proficient in MS Office (Word, Excel and Outlook), electronic medical records and web applications. This position requires a High level of computer literacy, ability to type at least 50 wpm
Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Movement within health center complex environment repeatedly throughout the day
Ability to write by hand, use phone, use computer keyboard and mouse extensively to perform general office functions
Manual and finger dexterity and wrist-finger speed sufficient to perform repetitive actions for extended periods of time
Ability to effectively communicate by hearing continuously and speech in a manner which can be understood by a diverse population
Ability to give and follow verbal and written instructions with attention to detail and accuracy
Must have visual acuity near and far (20 inches to 20 feet), depth perception, field of vision, ability to focus on an object, ability to identify and distinguish colors
Ability to sit or stand for minimum period of one (1) hour
Ability to frequently walk, bend, squat, stoop, kneel, twist, crouch, and climb with the use of a step stool
Ability to grasp, hold and pick up and reach with hands and arms
Ability to frequently lift and or move up to fifteen (15) pounds
Ability to occasionally lift and carry up to thirty-five (35) pounds (periodic lifting of supplies or equipment)
Ability to coordinate multiple tasks simultaneously
Petaluma Health Center