• Job Description

  Req#: 564753
  Clinica Sierra Vista is excited to be one of the largest Federally Qualified Health Centers in the Nation! We’re honored to serve the men and women of the fields. We also offer care and support to the inner city, the rural and isolated, those of low, moderate, and fixed incomes, and families from an array of cultural backgrounds who speak several languages. We don’t inquire about immigration status because we simply don’t need to know. If you come to us, we will treat you like any other patient.

  • As we grow our team, we are looking for individuals who believe the patient is always #1.

  Why work for us?

  • Competitive pay which matches your abilities and experience
  • Health coverage for you and your family
  • Generous number of vacation days per year
  • A robust wellness plan and health club discounts
  • Continuing education assistance to grow and further your talents
  • 403(B) plan with company matching

  Intrigued? We’d love to hear from you! Please review the job details below and then click “apply.”

  We're looking for someone to join our team as a Referral Clerk who:

  Under the direction of the Referral Supervisor or Referral Manager, the Referral Coordinator I is responsible for the processing of new referrals for a variety of medical services/procedures for patients as requested by the primary care physician. As an integral member of the patient’s health home, Referral Coordinator I will collaborate with medical providers, insurance companies and external specialty partners to ensure patients referrals are processed in accordance to department of health care guidelines.

  Essential Functions:

  • Tracks and enters all referral requests in the Referral Tracking System or EHR daily.
  • Evaluates specialty referrals based on medical necessity and managed care rules.
  • Produces an accurate weekly report of processed referrals (minimum of 65-70 referrals) to management following tracking and benchmark expectations reviewed upon hire.
  • Prepares and processes referral and pre-authorization paperwork for specialty visits, by creating a comprehensive referral packet, including demographics, eligibility verification and authorization for services, primary care provider referral, and primary care provider notes, diagnostics, or lab work pertinent to the specialty referral.
  • Verifies insurance information for referral purposes and processes insurance information for referral patients.
  • Answers, responds, and documents phone calls, requests, and questions from patients in a timely manner. Calls must be accurately managed or redirect as appropriate.
  • Routinely provides patients with other clinic and community-based resource materials as appropriate.
  • Monitors electronic health record (EHR) notifications throughout the day to capture referral requests in real time.
  • Utilizes third party payer/insurance portals; understands insurance providers, their portals and their expectations for authorization approvals.
  • Ensures proper use of CPT and current ICD-10 codes to meet the requirements of third-party payers and specialty clinics to ensure minimal delay in securing referral appointments or pre-authorizations.
  • Utilizes EHR functions to document all pertinent information.
  • May perform referral tracking process utilizing the EHR or other established system.
  • Organizes and prioritizes workload based on acuity.
  • Maintains confidentiality by following all applicable HIPAA regulations.
  • Other duties as assigned.

  
  

  You'll be successful with the following qualifications:

  • Graduation from High School or equivalent GED.
  • Graduate of an accredited Medical Assistant program preferred.
  • Two (2) to three (3) years medical back office or administrative medical experience in a community healthcare preferred but not required.
  • Bilingual in Spanish preferred but not required.
  • Previous experience with specialty referrals in community health desired.
  • Intermediate computer skills required.
  • Must adhere to Clinic Sierra Vista’s employee health/immunization requirements or provide a valid exemption request for subsequent approval.
  • Valid CA Driver’s License and proof of insurance.
  • Must adhere to Clinica Sierra Vista's employee health/immunization requirements or provide a valid exemption request for subsequent approval.

  
  

  Clinica Sierra Vista values human rights, goodwill, respect, inclusivity, equality, and recognizes that the organization derives its strength from a rich diversity of thoughts, ideas, and contributions. As leaders in healthcare industry, we aspire to be an employer of choice by promoting an organizational culture that reflects these core values. We seek to attract, develop, and retain a talented and dedicated workforce where people of diverse races, genders, religions, cultures, political affiliations and lifestyles thrive. Our goal is to create a welcoming and inclusive environment that empowers our employees to provide the highest level of service to our community of residents and businesses; they’re counting on us.

  Clinica Sierra Vista is an equal opportunity employer and strives to attract qualified applicants from all walks of life without regard to race, color, ethnicity, religion, national origin, age, sex, sexual orientation, gender identity, gender expression, marital status, ancestry, physical disability, mental disability, medical condition, genetic information, military and veteran status, or any other status protected under federal, state and/or local law. We aim to create an environment that celebrates and embraces the diversity of our workforce. We welcome you to join our team!

• About the company

  Clinica Sierra Vista is proud to offer comprehensive health care to the underserved, underinsured, and uninsured of Kern, Fresno, & Inyo Counties. Learn more.

Notice