Job DescriptionLying just inland between the State's coastal mountain ranges and the Sierra Nevada Mountains, Adventist Health Reedley has been serving the Central Valley since 2011. We are comprised of a 49-bed acute care hospital and 60 clinics in 27 rural communities with primary and specialty care services. Reedley is a perfect location for outdoor enthusiasts as it is located in the central San Joaquin Valley portion of California, close to Yosemite, Sequoia and Kings Canyon National Parks. In addition to the beautiful landscape, it also offers a great cost of living and close-knit communities. Job Summary: Manages incoming and outgoing referrals from Imaging, primary and specialty providers in a timely and professional manner; schedules appointments according to practice policy; maintains positive relations with referral sources; schedules appointments from third party electronic referral systems, fax, email and web requests; and participates in marketing to referring practices. Provides quality customer service & patient financial responsibilities to patients, referring physicians, visitors and internal customers by obtaining insurance authorization and benefit verification for imaging procedures and specialty referrals. Job Requirements:Education and Work Experience:
- High School Education/GED or equivalent: Preferred
- Associate's/Technical Degree or equivalent combination of education/related experience: Preferred
Essential Functions:
- Processes inbound and outbound referrals, verifies referrals are correctly ordered according to protocols in the EHR. Obtains benefit verification and necessary authorizations (referrals, pre-certification) prior to patient arrival for all ambulatory visits, procedures, injections and radiology services.
- Uses online, web-based verification systems and reviews real-time eligibility responses to ensure accuracy of insurance eligibility. Verifies patient demographic information and insurance eligibility including coordination of benefits; updates and confirms as necessary to allow processing of claims to insurance plans.
- Serves as navigator and point of contact for patients and families, with patients and families having direct access for asking questions and raising concerns. Occasionally assumes advocate role on the patient's behalf with the carrier to ensure approval of the necessary supplies/services for the patient in a timely fashion. Assists patient in problem-solving potential issues related to the healthcare system, financial or social barriers (e.g., request interpreters as appropriate, transportation services or prescription assistance)
- Maintains satisfactory productivity rates and ensures the timeliness of referral and scheduling while maintaining work queue goals.
- Collaborates effectively with Care Connection Center associates and responds to provider (internal and external) and support staff questions, requests and concerns regarding the status of patient referrals, care coordination or follow-up status.
- Performs other job-related duties as assigned.
Organizational Requirements: Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations, including, but not limited to, measles, mumps, flu (based on the seasonal availability of the flu vaccine typically during October-March each year), COVID-19 vaccine (required in CA, HI and OR) etc., as a condition of employment, and annually thereafter. Medical and religious exemptions may apply.About UsAdventist Health is a faith-based, nonprofit, integrated health system serving more than 90 communities on the West Coast and Hawaii with over 400 sites of care, including 26 acute care facilities, clinics, home care, and hospice agencies in both rural and urban communities. Our compassionate and talented team of 37,000 includes employees, physicians and volunteers driven in pursuit of one mission: living God's love by inspiring health, wholeness and hope.