Eligibility and Referral Coordinator - Newport Beach, CA

Position Summary:

We are seeking a highly organized and detail-oriented Eligibility and Referral Coordinator to join our dynamic dermatology office team. This position is vital for ensuring seamless coordination of patient referrals, fostering effective communication among healthcare providers, and enhancing the overall patient experience.

Pay and Hours:

$18-$21/hr. 8 hours per day, 3-4 days per week. 

Essential Functions:

To perform effectively in this role, the candidate must fulfill the following duties with or without reasonable accommodations:

• Receive and review referral requests from internal and external sources for accuracy and completeness.
• Ensure all necessary documentation is included and meets required standards.
• Collaborate with referring healthcare providers to gather additional information as needed.
• Communicate with patients to explain the referral process and schedule specialist appointments.
• Maintain open, professional lines of communication with healthcare professionals and patients.
• Maintain accurate, up-to-date records of all referral activities in the electronic health record (EHR) system.
• Generate reports on referral status and outcomes for management review.
• Insurance Verification:
• Verify insurance coverage for referred services and provide patients with relevant information.
• Coordinate with billing and insurance teams to address pre-authorization requirements.
• Efficiently navigate local IPA/HMO portals, including Optum, Hoag Physician Partners, and Availity.
• Schedule patient appointments with specialists or arrange diagnostic tests as required.
• Ensure appointments align with both patient and specialist availability.
• Track and manage the status of pending referrals to ensure timely completion.
• Follow up with patients to confirm specialist appointments and address any concerns.
• Work closely with administrative staff, healthcare providers, and specialists to optimize referral workflows.
• Participate in regular team meetings to discuss and improve processes.

Knowledge, Skills, & Abilities:

• High school diploma or equivalent. Additional education or certification in healthcare administration is a plus.
• Experience in insurance eligibility verification and prior authorization within a medical setting, preferably dermatology.
• Proficiency in medical terminology, insurance processes, and electronic health record systems.
• Excellent verbal and written communication skills.
• Strong organizational abilities and attention to detail.
• Ability to work independently and collaboratively in a fast-paced healthcare environment.
• Familiarity with navigating IPA/HMO portals such as Optum, Hoag Physician Partners, and Availity.

This role requires a proactive, dependable, and detail-oriented individual with the ability to manage multiple tasks in a dynamic healthcare environment. The ideal candidate demonstrates a strong commitment to patient care and operational excellence.

Physical and Mental Demands:

The physical and mental demands described below are representative of those required to perform this job successfully. Reasonable accommodations may be made for individuals with disabilities:

• Physical Requirements:
• Occasionally required to stand, walk, and sit for extended periods.
• Use hands to handle objects, tools, or controls; reach with hands and arms.
• Occasionally required to climb stairs, balance, stoop, kneel, bend, crouch, or crawl.
• Occasionally lift, push, pull, or move up to 20 pounds.
• Vision Requirements:
• Close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.

Note:
This job description is intended to provide a general overview of the role. Additional responsibilities may be assigned, or duties modified by the department supervisor based on operational needs.