Job Description: Description: Processes internal and external medical referrals; reviews referral for completeness and requests additional information as necessary; verifies member eligibility, refers to nurse for review and/or member/provider outreach. Maintains relationships with physicians, and members with regard to questions and problems with referrals, including keeping outside providers updated on pertinent information to process referrals. Manages external referrals and data for processing. Performs other duties as assigned by management.
Performs a variety of procedures to process medical referrals, external clinical record management, functions as a liaison, and works independently; verifies member eligibility, ensures appropriate nurse assistance, enters information in the system; and outreaches members for scheduling and approvals as needed; responds quickly to meet member/patient needs and resolves problems.
Synthesizes & analyzes a large volume of data related to the member, benefits, eligibility, facilities, contracts, & clinical information, continuity of care, quality of care & optimal resource management for the patient. Ensures timely accurate processing resulting in making members/patients and their needs a primary focus of one's actions; accurate department processes to ensure quality processing.
Considers how timely and accurate referral processing will affect members. Informs patients and providers of referral process and limitations, associated charges, appointments, and member responsibilities. Answers questions concerning eligibility, benefit coverage, referral policies and procedures, coordination of benefits and contracts.
Performs other duties as assigned.
Basic Qualifications: Experience
Minimum 6 months previous experience in the healthcare industry. Education
High School Diploma or General Education Diploma (GED) required. License, Certification, Registration
Medical Assistant Certification required.
Demonstrated ability to read/interpret provider orders.
Demonstrated customer service skills, customer focus abilities, and the ability to understand Kaiser Permanente customer needs.
Completion of a Medical Assistant training program of at least six months in duration for the Medical Assistant.
Copy of diploma and transcripts from program required.
Medical Terminology preferred.
Primary Location: Colorado,Colorado Springs,Colorado Springs Administrative Offices 1975 Resea Scheduled Weekly Hours: 1 Shift: Day Workdays: Mon, Tues, Wed, Thurs, Fri, Sat, Sun Working Hours Start: Varies Working Hours End: Varies Job Schedule: Call-in/On-Call Job Type: Standard Employee Status: Regular Employee Group/Union Affiliation: SEIU - Local 105 Job Level: Entry Level Job Category: Patient Care Services (Non RN) Department: Navigation Team Travel: Yes, 5 % of the Time 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.
External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances.