Referral and Authorization Coordinator

Native Preference in hiring is given to qualified enrolled members of Paskenta Band of Nomlaki Indians and Native Americans in accordance with the Band’s Preference Policy, Chapter 1-715 of the Paskenta Band of Nomlaki Indians Tribal Policies). Applicants claiming Indian Preference must submit verification of Indian certified by tribe of affiliation or other acceptable documentation of Indian heritage.

POSITION SUMMARY

The Referral and Authorization Coordinator at Rolling Hills Clinics is responsible for compiling, processing, and maintaining electronic and traditional medical records of clinic patients in a manner consistent with medical, administrative, ethical, legal, and regulatory requirements. This role will work directly with Paskenta Nomlaki Tribal Members. Employee will provide patient care by caring for their sensitive medical information and maintain HIPAA. The qualified candidate will be well adept in following policies and procedures regarding outgoing correspondence in a timely manner. The Referral and Authorization Coordinator will work directly with Tribal Members, providers and facilities to efficiently coordinate referrals and obtain authorizations for in-house, outside providers and healthcare entities.

DUTIES & RESPONSIBILITIES

• Appropriately and respectfully answers questions about Rolling Hills Clinic and Tribal Member Support Department by providing appropriate and accurate information as needed.
• Offers assistance with the patient portal, and all other healthcare requests.
• Consistently verifies patient demographics are correct and current for every patient by keeping the Electronic Medical Record and all other data collecting clinic files, records, forms, and spreadsheets updated.
• Protect the security of medical records to ensure that confidentiality is maintained, HIPPA.
• Must be a self-starter, ensuring daily duties are completed without constant supervision.
• Ability to provide feedback, present problems in a professional manner and accept constructive critiquing both on an individual basis and within a group. Communicate clearly and concisely.
• Handles inbound telephone and written inquiries from providers and staff regarding referral/prior authorization by screening and reviewing requests based on benefit plan/insurances, client specifics, clinical criteria and the needs of the Tribal Member maintaining patient advocacy.
• Process and follow-up all incoming-outgoing referrals and authorizations in a timely manner according to RHC guidelines and consistently communicate updates with Tribal Member and supervisor. Documents all communications appropriately.
• Keep records of incoming and outgoing records/requests in an Excel or like format and update the Electronic Medical Record.
• Employee Safety: Safely performs all duties; follows required protective protocols to ensure personal safety as well as the safety of others.
• Must maintain compliance with ergonomic safety standards; be mindful of posture and regularly practice ergonomic stretches.
• Safety: Responsible for ensuring that all duties, responsibilities, and operations are performed with the utmost regard for the safety and health of all personnel involved, including themselves.
• Safety: Take appropriate corrective actions to address matters pertaining to employee health and safety that have been brought to their attention.
• Other duties as assigned by Supervisor.

MINIMUM JOB QUALIFICATIONS

• High School Diploma, GED, or equivalent work experience, Certified Medical Assistant or one year experience working in a medical facility is preferred.
• Detail-oriented, organized, and a team player.
• Highly proficient with computer systems, technology, and standard office equipment including computers, fax machines etc.
• Familiar with medical concepts/terminology medications, procedures and medical tests, and technology
• Outstanding customer service skills with a commitment to accuracy, detail, and HIPPA confidentiality even while under pressure.
• Impeccable emotional intelligence and listening skills.
• Excellent communication and interpersonal skills.
• Must have ability to relate and communicate effectively with community interest groups, agencies, and medical facilities that serve the American Indian Community.
• Reliable time-management, punctuality, is seldom tardy and or absent attends mandatory in-service programs and/or committees as assigned.
• Pass a mandatory drug test and alcohol screening.
• Current BCLS and First Aid Certification (may complete within the first 30 days of hire)
• Phone Etiquette: speak clearly, be succinct as possible, do not interrupt while the other person is talking, give the caller your full attention, and maintain a polite and positive tone of voice.

BACKGROUND CHECK REQUIREMENTS

Pre-employment Drug Testing and a Department of Justice Fingerprinting clearance through Federal, State and Child Abuse Index is a contingency for an offer of employment. Criminal clearances are obtained to protect the welfare and safety of clients receiving services at Rolling Hills Clinic.

VACCINATION REQUIREMENTS

A pre-employment Physical exam is required upon hire. You will be required to provide vaccination records to show proof of immunity for TB or PPD, Measles, Mumps, Rubella, Varicella, TDAP & Hep B. If the records are more than 10 years old, titers are required to confirm immunity.

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to talk and listen. The employee frequently is required to stand, walk, sit, use hands to finger, handle, or feel; and reach with hands and arms. The employee is occasionally required to stoop. The employee must occasionally lift and/or move up to 50 pounds. Position may require exertion up to 20 pounds of force occasionally and/or up to 10 pounds of force frequently or constantly lift, carry, push, pull or otherwise move objects. Specific vision abilities required by this job include close vision, distance vision, color vision peripheral vision, depth perception and ability to adjust focus.

WORK ENVIRONMENT

Work is performed in a health clinic setting. The noise level in the work environment is usually low to moderate. Will work with blood-borne pathogens and will require OSHA training. This job routinely uses standard office equipment such as computers, telephones, photocopiers, and fax machines. The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Employment with Rolling Hills Clinic is voluntarily entered. All RHC personnel are employed on an at-will basis. At-will employment may be terminated with or without cause, and with or without notice at any time by the employee or by RHC. No manager, supervisor, or employee of the organization has any authority to enter into an agreement for employment for any specified period of time or to make an agreement for employment other than at-will terms. The job description does not constitute an employment agreement between Rolling Hills Clinic and employee and is subject to change by the Paskenta Band of Nomlaki Indians