Medical Referral Clerk (Winnetka)

JOB SUMMARY

This position will coordinate patient referrals between healthcare providers. This position will also process HMOs, Medi-Cal, Medicare, and MHLA referrals.

ESSENTIAL RESPONSIBILITIES

• Process referral requests, verifying insurance eligibility.
• Obtain necessary authorizations and enter data to generate authorization numbers.
• Present prospective and retrospective referrals to the UR meeting.
• Maintain logs to track prospective, retrospective, and denials.
• Submit required UM reports to the health plans in a timely fashion.
• Coordinate with the Claims Adjudicator and Case Managers about patient referrals, claims, and case management.
• Liaise among patients, Managed Care Department, providers, specialists, hospitals, and health plans on referrals.
• Assist providers and specialists with the referral process.
• Participate in the preparation of funding audits.
• Generate and review patient referral utilization reports.
• Facilitate scheduling of appointments with referred healthcare providers.
• Perform other duties as assigned.

KNOWLEDGE / SKILLS / ABILITIES

• Knowledge of medical referral processes and procedures.
• Knowledge of basic medical terminology, CPT codes, and ICD10.
• Ability to be well-organized and precise.
• High level of professionalism, customer service, and interpersonal skills.
• Strong computer skills in Microsoft Office.
• Ability to communicate in an articulate, professional manner while maintaining a necessary degree of confidentiality.
• Ability to work independently, meet deadlines, and multi-task while maintaining quality standards.
• Ability to pleasantly and effectively represent the organization.

EDUCATION / EXPERIENCE

• High school diploma or equivalent OR a combination of education and related work experience.
• 1 to 2 years of related experience.

CERTIFICATIONS / LICENSURE / LANGUAGE

• Must provide proof of required vaccinations by federal, state, and local funding sources.
• Bilingual (English/Spanish) preferred.
• BLS/CPR certification preferred.
• Employees driving personal vehicles for El Proyecto business must provide El Proyecto proof of a valid driving license, and auto liability insurance.
• El Proyecto will reimburse employees for their mileage at the current rate set by the Internal Revenue Service. To receive mileage reimbursement, the employee must log their mileage and submit the mileage expense report to their Appropriate Administrator.

PHYSICAL REQUIREMENTS

• Walking, talking, sitting, bending, stooping, and lifting up to 10 pounds; hand and wrist dexterity to utilize a computer.
• AN EQUAL OPPORTUNITY AND AFFIRMATIVE ACTION EMPLOYER -