Medical Referral Clerk (Winnetka)

Must feel comfortable working in a fast-paced environment.

Bilingual in English and Spanish preferred.

Must feel comfortable working with underserved communities.

Able to adapt to evolving operational needs highly preferred.

Previous experience submitting and obtaining referrals preferred.

JOB SUMMARY

This position will coordinate patient referrals between healthcare providers. This position will also process HMOs, Medi-Cal, Medicare, and MHLA referrals.

ESSENTIAL RESPONSIBILITIES

• Process referral requests, verifying insurance eligibility.
• Obtain necessary authorizations and enter data to generate authorization numbers.
• Present prospective and retrospective referrals to the UR meeting.
• Maintain logs to track prospective, retrospective, and denials.
• Submit required UM reports to the health plans in a timely fashion.
• Coordinate with the Claims Adjudicator and Case Managers about patient referrals, claims, and case management.
• Liaise among patients, Managed Care Department, providers, specialists, hospitals, and health plans on referrals.
• Assist providers and specialists with the referral process.
• Participate in the preparation of funding audits.
• Generate and review patient referral utilization reports.
• Facilitate scheduling of appointments with referred healthcare providers.
• Perform other duties as assigned.