Patient Services Coordinator-Provider Relations Riverside
Patient Services Coordinator-Provider Relations Riverside
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$ 47874 - 71249
1 Vacancy
Job Description
ABOUT THE POSITION
The County of Riverside Riverside University Health System (RUHS) Provider RelationsDepartmentis seekingto fill twoPatient Services Coordinator positions located in Riverside.
Under minimal supervision performs a variety of administrative and clerical duties in support of the Riverside University Health System (RUHS) Managed Care or Care Management program secures authorization for services completes patient assessments for eligibility criteria; and performs other related duties as required.
Depending on area of assignment the Patient Services Coordinator reports to either the Nurse Coordinator Director of Nursing Services or an appropriate Revenue Cycle Manager. The Patient Services Coordinator class is primarily responsible for coordinating patient care at the RUHS ambulatory clinics or for coordinating referrals generated with contracted Managed Care Plans both public and private. In addition this class coordinates with physicians and midlevel providers regarding patient care or IPAs for all patients scheduled for appointments at RUHS and obtains all authorizations necessary for patient care.
Other duties include but are not limited to the following:- Submitting and obtaining authorization services which includes clinic visits specialty visits outpatient surgeries and eConsults.
- Liaison between healthcare staff and patients regarding maintenance of care and treatment.
- Daily intake and outbound calls to input data into EMR and verify member eligibility.
- Customer service and tracking of pending referrals.
- Ensuring correct CPT and ICD10 codes are valid.
- Submits/Obtains authorization from the payer.
- Running eligibility.
- Manages ED and Inpatient discharges.
- Procures authorization.
- Incoming/Outbounds calls.
- Authorization insurance and eligibility experience.
- Strong customer service skills.
- Clinical background.
Work Location:Mission Grove 7888 Mission Grove Pkwy Riverside Ca 92508 Telecommuting position
Meet the Team!Riverside University Health System
EXAMPLES OF ESSENTIAL DUTIES
Assist physicians and other healthcare providers by providing care coordination to ensure patients receive optimal care; interact with Primary Care Providers Specialty Providers and other healthcare staff to coordinate care for patients.
Liaison between healthcare staff and patients regarding maintenance of care and treatment; work closely with Providers to ensure continuity of care and treatment; facilitate communication among patients physicians nurses and other healthcare staff regarding their care including making appointments treatment authorizations and resource needs.
May assist with patient referrals to appropriate community resources; may provide patient education.
Daily management of referrals which includes input of data into manage care system verify member eligibility provider participation and tracking of pending referrals.
Authorize Treatment Authorization Requests (TAR) for the County of Riverside Medically Indigent Services Program (MISP); coordinate Durable Medical Equipment (DME) for all Managed Care Health Plans public and private coordinating quotes and equipment availability.
Assist with transfer of patients to and from RUHS Medical Center and Care Clinics and other outlying hospitals for specialized care; verify patient eligibility with associated health plans.
Coordinate with contracted IPAs and return copies of all appropriate clinic surgery and emergency room progress notes; process and authorize all requests for pharmacy that are not covered in the Drug Formulary.
Request and review all emergency room notes for managed care patients that are seen through the Emergency Department; ensure return of all notes (i.e. outpatient surgical and emergency) to appropriate PCP or IPA.
Coordinate patient transfers to other facilities for higherlevel of care; coordinate with Medical Social Workers to facilitate care for patients; assist patients in qualifying for MediCal or other programs.
Process Third Party claims by determining and supplying information to and from attorney respective of patients eligibility at the time of an accident.MINIMUM QUALIFICATIONS
Education:Graduation from high school or possession of a Certificate of Proficiency issued by the California State Board of Education or attainment of a satisfactory score on a G.E.D. test.
Experience: Three years of increasingly responsible broad and varied clerical experience at least one year of which included working in a managed care healthcare or behavioral health setting. For the RUHS care management program experience as a Licensed Vocational Nurse or experience equivalent to the County of Riverside Behavioral Health Specialist I class is preferred.
Knowledge of: Rules and regulations pertaining to the confidentiality of medical information from federal state and county agencies; medical terminology and basic laws of healthcare facilities and hospitals; federal state and county regulations related to healthcare compliance.
Ability to: Interpret medical information diagnosis and apply medical guidelines; communicate effectively orally and in writing; maintain effective working relationships with a wide variety of individuals; work independently as well as in a team environment; operate a variety of telephone technology systems; understand the capabilities and applications of information processing equipment considering the requirements of the program; utilize motivational interviewing skills; work efficiently in a fast paced environment; provide excellent customer service.SUPPLEMENTAL INFORMATION
For additional information or questions regarding this recruitment contactAnaySanchezat
APPLICATION INFORMATION
Veterans Preference
The County has a Veterans Preference Policy applicable to new hires. To qualify upload a copy of your (or your spouses) Member4 Form DD214 indicating dates of service and a copy of your spouses letter of disability (if applicable) with your application. For privacy reasons it is recommended that you remove your social security information from the document(s). A Human Resources Representative will review the materials and determine if you qualify for veterans preference.The Veterans Preference Policy C3 is available here: https://rivcocob/boardpoliciesReasonable Accommodations
The County of Riverside is committed to providing reasonable accommodation to applicants as required by the Americans with Disabilities Act (ADA) and Fair Employment and Housing Act (FEHA). Qualified individuals with disabilities who need a reasonable accommodation during the application or selection process should contact the recruiter for the position noted above. For additional information and/or to obtain the appropriate form for requesting a reasonable accommodation please visit the Disability Access Office web page located at: https://rchr/disabilityProof of Education
If using education to qualify or when requested by the recruiter upload a copy of any license(s) official/unofficial transcript(s) degrees and/or related employment documents to your NeoGov account at the time of application and before the closing date. Official or unofficial transcripts will be accepted.If your education was completed outside of the United States you will need to provide a copy of your Foreign Education Equivalency evaluation from a member of the National Association of Credential Evaluation Services NACES or Association of International Credential Evaluators Inc. AICE.
Equal Opportunity Employer
The County of Riverside is an Equal Opportunity Employer. It is the policy of the County of Riverside to provide equal employment opportunities for all qualified persons. All applicants will be considered without regard to race color religion sex national origin age disability sexual orientation gender gender identity gender expression marital status ancestry medical condition (cancer and genetic characteristics) genetic information or denial of medical and family care leave or any other nonjobrelated factors.PreEmployment
All employment offers are contingent upon successful completion of preemployment requirements including a criminal background investigation which involves fingerprinting. (A felony or misdemeanor conviction may disqualify the applicant from County employment). A preemployment physical examination and background check may be required.Probationary Period
As an Approved Local Merit System all County of Riverside employees except those serving At Will are subject to the probationary period provisions as specified in the applicable Memorandum of Understanding County Resolution or Salary Ordinance. Temporary and Per Diem employees serve at the pleasure of the agency/department head.General Information
Current County of Riverside and/or current employees of the hiring department may receive priority consideration. Qualified candidates may be considered for future County vacancies.Job postings may close without notice based on application volume. Submit your complete application by the recruitment close date; no late applications are accepted. Ensure all relevant experience/education is reflected on your application/resume as a failure to demonstrate position requirements may disqualify applicants. A description of job duties directly copied from the job classification or job posting will not be considered.
Please read and follow any special application instructions on this posting. Click the Apply link located on this page to submit your application. For additional instructions on the application process examinations Veterans preference preemployment accommodation or other employment questions please refer to our web site www.rchr.
If you are experiencing technical problems you may contact the governmentjobs applicant support desk Monday through Friday 6 am to 5 pm Pacific Time at or tollfree.
Required Experience:
IC
Employment Type
Full-Time
