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Job Opening details:-
Company Name :- Alura Workforce Solutions
Position Name :- Referral Coordinator
Company Location :- Fountain Valley, CA 92728
Job Category : data entry Jobs
Full Job Description :-
UM Referral Coordinator
The UM Referral Coordinator is responsible for providing technical, administrative, and clerical support for the Utilization Management department, working closely with the Nurse Case Managers and Physician Reviewers. This position creates and assists with the preparation of referral requests. As part of the preparation process will verify eligibility, benefits, request any needed clinical notes and accurately complete or forward referral to higher level of review. Ensures that all referral policies and procedures are followed as required to meet all contractual, regulatory, and federal requirements.
Research and process incoming referral requests received via fax or Provider Portal generated
Check Health Plan eligibility and benefits as needed
Gather clinical notes and Health Plan criteria as needed
Scan and attach faxed clinical information to referral in system
Demonstrate good problem-solving skills
Provide a high standard of customer service for Health Plan members, Providers, and clinic staff
Demonstrates professional and courteous communication skills.
Ability to follow company policies, procedures, and directives
Ability to interact in a positive and constructive manner
Ability to prioritize, multitask with attention to detail and timeliness for task completion.
Perform any additional duties that may not be inclusive in job description as requested by Management team that is within the scope of knowledge or ability of the Referral Coordinator.
Excellent computer skills
Knowledge of medical terminology
Customer service and interaction with patients/members
Ability to handle difficult calls and maintain professional conduct
High School Diploma or GED equivalent
Medical Assistant Certificate preferred
2 years of experience in healthcare setting; medical office, hospital; health plan
Excellent verbal and written communication skills
Keyboard speed and accuracy, 40-50 wp
Must be detail oriented and have excellent organizational skills
Must be able to work independently, but also in a team structure
Accurate data entry and documentation into all appropriate systems
Attends all staff meetings and in-services
Maintains the principles of member confidentiality in every interaction
Willingness to be flexible with job responsibilities
Proficiency with EPIC and Tapestry
Assigns and moves cases to next level of review when appropriate
Validates that authorization requests are complete and requests additional data when necessary.
Knowledge of ICD-10 and medical terminology
Confirms member eligibility and benefits.
Able to serve as resource to other departments, i.e., claims, network, member services
Demonstrates the ability to explain managed care principles, i.e., contracted, non-contracted, full risk, shared risk, in-network, out-of-network
Monday through Friday 8AM – 5PM, remote position with 1 day/week work in office
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