Patient Services Coordinator

The County of Riverside Riverside University Health System (RUHS) CHC Jurupa ValleyDivision is seeking a detail-oriented and experienced Patient Services Coordinator with a strong background in medical insurance and prior authorization processes. The ideal candidate will have hands-on experience verifying patient benefits obtaining prior authorizations for medical procedures or medications and working directly with insurance providers to ensure timely and accurate approvals.

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.

The Patient Services Coordinator will be primarily responsible for coordinating referrals generated with contracted Managed Care Plans both public and addition this class coordinates with physicians and mid-level providers regarding patient care or IPAs for all patients scheduled for appointments at RUHS and obtains all authorizations necessary for patient care.

Main duties include but are not limited to the following:

• Case management duties
• 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 ICD-10 codes are valid
• Submits/Obtains authorization from the payer
• Running eligibility
• Manages ED and Inpatient discharges
• Procures authorization
• Incoming/Outbounds calls

The most competitive candidates will have the following experience:

• Care coordination with patients
• Communication skills/ team player
• Authorization insurance and eligibility experience
• Strong customer service skills
• Clinical background
• Bilingual

Meet the Team!
Riverside University Health System provides a wide range of primary and specialty care services across 13 Community Health Centers (CHCs) throughout Riverside County. As federally qualified health centers the CHCs operate on a sliding fee scale to ensure that some of the countys most vulnerable populations receive the care they need.

Whether its preventive care chronic disease management Express Care Mobile Health or integrated specialty and behavioral health services our teams are made up of dedicated healthcare professionals who are passionate about making a difference.

If youre committed to delivering compassionate care and eager to join a team that truly values community connection and making a meaningful difference RUHS is the place for you!

Learn more about our Community Health Centers by visiting

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 higher-level of care; coordinate with Medical Social Workers to facilitate care for patients; assist patients in qualifying for Medi-Cal 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.

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.

Requires a valid California drivers license for participation in mandated trainings and off-site meetings.

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.

For further information regarding this posting contact the recruiter:Anay Sanchez at or call .Due to the high volume of calls please allow up to 2 business days to receive a response.

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) Member-4 Form DD-214 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 Veterans Preference Policy C-3 is available here: 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: 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).

Work Authorization Requirement
Applicants must be legally authorized to work in the United States at the time of application. The County of Riverside does not participate in visa sponsorship programs including H1-B visas and will not provide sponsorship for any employment-based visas.

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 non-job-related factors.

Pre-Employment
All employment offers are contingent upon successful completion of pre-employment requirements including a criminal background investigation which involves fingerprinting. (A felony or misdemeanor conviction may disqualify the applicant from County employment). A pre-employment 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 pre-employment accommodation or other employment questions please refer to our web site .

If you are experiencing technical problems you may contact the applicant support desk Monday through Friday 6 am to 5 pm Pacific Time at or toll-free 1-.