Referral Coordinator Lead
Primary Location Modesto, California
Worker Location Flexible
Facility Modesto Medical Center
Job Number 1337889 Date posted 02/27/2025
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Description:
Job Summary:
Under limited supervision, analyzes, reviews and processes referrals for authorization of outside medical services for all referral type sand specialities, with specific responsbility for a subset of team members for a specific business/referral focus area.Researches and resolves inquiries from outside providers, educates members, physicians, outside providers and staff regarding the referral process, with specialized focus areas. Assist in training new hires. Updates and edits authorization into the Outside Medical Services system. Recommends changes/additions to enhance service levels and cost benefits.
Essential Responsibilities:
- Reviews, evaluates and processes each outside medical servies referrals for completeness, accurarcy and timeliness.
- Determines the appropriate coverages, service codes and providers to support financial reporting, obtain required approvals and issues notifications to complete each outside medical services referrals.
- Assist supervisor in coaching and mentoring of Referral Coordinators.
- Assist in the development of job aids,DLPs (desk level procedures) and training materials to support the examiners efficiency and knowledge.
- Process referrals for specific set of medical procedures, services and providers by following policies and procedures.
- Conducts referral report reviews, analysis, corrections and communications as part of the referral and authorization process.
- Prepares and delivers service reports to assigned areas (by specialty or medical center).
- Provide customer service to various referral process stakeholdrs (e.g. patient, provider, case manager, etc.) by responding to inquiries related to authorization and referrals.
- Collaborate with clinical case managers and case coordinators to ensure accurate and timely authorization processes. Inquire with referring providers when referral information requirements are not met.
- Act as a primary contact for medical center stakeholders and physicians.
- Ensure outside providers agreement are in place by confirming contract status or requesting letter for payment. Code referrals accurately to indicate any special claims handling requirements.
Basic Qualifications:
Experience
- Two years experience as a referral coordinator or provider relations, claims coordinators, benefit analysis.
Education
- Associate degree OR four (4) years of experience in a directly related field, with demonstrated proficiency in medical terminology High School Diploma or General Education Development (GED) required.
License, Certification, Registration
- N/A
Additional Requirements:
- Previous medical assistance, utilization management/authorization or coding experience in a hospital or clinic environment.
- Previous experience working with health information or medical records/database systems.
- Knowledge of medical terminology or medical coding.
- Excellent customer service, telephone presentation and problem solving skills.
- Ability to prioritize work in a high volume demanding environment.
- Must be able to work in a Labor/Management Partnership environment.
Preferred Qualifications:
- Bachelors degree preferred.
- Proficiency in medical terminology, utilization management process, health plan benefit administration.
Primary Location: California,Modesto,Modesto Medical Center
Scheduled Weekly Hours: 40
Shift: Day
Workdays: Mon, Tue, Wed, Thu, Fri
Working Hours Start: 07:30 AM
Working Hours End: 04:00 PM
Job Schedule: Full-time
Job Type: Standard
Worker Location: Flexible
Employee Status: Regular
Employee Group/Union Affiliation: NUE-NCAL-09|NUE|Non Union Employee
Job Level: Individual Contributor
Department: Modesto Hospital - Othr Rgnl-Referral Invoice Svc - 0206
Pay Range: $35.09 - $45.37 / hour
Kaiser Permanente strives to offer a market competitive total rewards package and is committed to pay equity and transparency. The posted pay range is based on possible base salaries for the role and does not reflect the full value of our total rewards package. Actual base pay determined at offer will be based on labor market data and a candidate's years of relevant work experience, education, certifications, skills, and geographic location.
Travel: No
Flexible: Work location is on-site at a KP location, with the flexibility to work from home.
Worker location must align with Kaiser Permanente's Authorized States policy.
At Kaiser Permanente, equity, inclusion and diversity are inextricably linked to our mission, and we aim to make it a part of everything we do. We know that having a diverse and inclusive workforce makes Kaiser Permanente a better place to receive health care, a more supportive partner in our communities we serve, and a more fulfilling place to work. Working at Kaiser Permanente means that you agree to and abide by our commitment to equity and our expectation that we all work together to create an inclusive work environment focused on a sense of belonging and wellbeing.
Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status. Submit Interest
Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status. Submit Interest
