Description:

Essential Functions:

▪ Receives referral requests from providers and communicates with them, or a member of the patient’s care team, as needed

▪ Obtains prior authorizations for patient referrals to specialists and surgeries. Advises provider if authorization request is denied.

▪ Communicates with different insurance companies to process referrals appropriately and verifies eligibility of insurance for patients

▪ Requests appointments from appropriate specialty providers

▪ Verifies eligibility of insurance for patients

▪ Communicates with patients and informs them of referral status

▪ Requests consult notes once patient has been seen by specialist and closes referrals upon receipt.

▪ Communicates with Specialist regarding referral needs.

▪ Follows up on referrals with specialty providers and patients.

▪ Obtains ongoing knowledge, documentation, and updates of appropriate referral resources, required forms and key contact persons

▪ Reviews and assesses medical records for referral processing.

▪ Tracks and processes referral using NextGen Diagnostics and Referrals sections in the A/P section of the SOAP note.

▪ Prioritizes and processes referrals by urgency or PCP request.

▪ Completes referral data tracking for Quality Assurance programs.

▪ Complies with all state and federal laws and regulations, as they pertain to position including; HIPAA, sexual harassment, Scope of Practice, OSHA etc.

▪ Other duties as assigned.

Additional Skills & Qualifications:

• Excellent computer skills, preferably with Windows, including Microsoft Office Suite

• Excellent telephone and communication skills

• Must possess excellent organizational, writing, and verbal skills.

• Ability to work independently, set priorities, and work well under pressure.

• Ability to maintain a high degree of confidentiality

Minimum Qualifications:

▪ High School diploma or equivalent.

▪ Minimum of 1 year of experience in office setting

▪ Excellent computer and technology skills.

▪ Ability to communicate orally and in writing; professional demeanor and the ability to represent SNAHC in the community.

Preferred Qualifications:

▪ Experience with NextGen EHR/PM software.

▪ Knowledge of Medi-Cal, Medicare, and managed care plans

▪ Knowledge of medical terminology and medical procedure terminology

About TEKsystems:

We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.