Referrals and Authorizations Manager
Montage Medical Group Monterey, CA
- Expired: over a month ago. Applications are no longer accepted.
ESSENTIAL DUTIES AND RESPONSIBILITIES: include the following and other duties may be assigned:
- Oversee HIM staff duties of coordination of care for individual patients by:
- Process and track referrals and diagnostic orders
- Obtain insurance authorization as appropriate in a timely and thorough manner to maximize quality patient care, with knowledge of insurance benefits, in/out of network requirements, pre-determination services, and medical necessity; tracking authorizations and maintaining status and outcome of requests
- Have thorough knowledge of insurance payer and regulatory quality metrics requirements
- Coordinate specialty and diagnostic appointments with patients and specialists/facilities
- Generate and electronically transmit the summary of care document to the specialist prior to patient appointment for all care transitions
- Communicate to patients their referral responsibilities
- Follow up on overdue orders for referrals and diagnostics until results are obtained
- Communicate with community organizations, health plans, outside facilities, and specialist
- Prepare the patient chart prior to patient office visits by completing pre-visit planning: follow up on overdue orders, and note care gaps, pending medications needing a refill, etc.
- Perform patient reminder calls regarding follow up office visits and service
- Scan and file documentation correctly into patients’ electronic medical record
- Perform clerical duties (e.g., photocopying, typing, forms, mailing, faxing, etc.)
- Coordinate the daily operations of the department
- Establish appropriate staffing levels for the department
- Schedule staff, optimizing department coverage
- Verify and approve the time clock for staff
- Interview, hire, train, counsel, develop performance improvement plans, conduct annual performance reviews, and disciplinary action as needed
- Oversee orientation and ensure employees receive adequate training and ongoing education
- Provide ongoing employee feedback of job performance
- Provide positive feedback as well as constructive criticism
- Conduct mandatory staff meetings and participate in huddles
- Organize education activities for staff, as necessary
- Establish and maintain a high level of employee engagement and morale
- Promote teamwork and empower teams and individuals to meet their potential
- Support quality and efficiency improvement efforts with a primary focus on MMG’s priority initiatives
- Develop personal education to be proactive in meeting the future needs of the practice
- Demonstrate a positive attitude toward all patients and customers
- Project positive, professional image
- Maintain a high degree of knowledge of the policies and procedures of the practice
- Must be able to learn, apply, and teach a variety of rules, regulations, policies, and procedures applicable to the ever-changing healthcare environment
- Maintain a working knowledge of CPT, HCPCS, ICD-10 and HCC coding
- Monitor patient experience scores and develop action plans for improving
- Monitor monthly operation reports and provide an explanation of variances
- Implement and monitor established workflows surrounding quality metrics, specifically relating to at-risk insurance contracts such as Aspire and Central California Alliance for Health
- Consult with Upper-Level Management regarding any problems or concerns, and assist in implementing organizational changes
- Monitor the coordination of care for individual patients by verifying the completion of the referral process through to receiving test and referral results
- Apply the principles of comprehensive, community-based, patient-centered, developmentally appropriate, and culturally and linguistically appropriate care coordination
- Monitor and develop referral sources to improve the timeliness in care coordination
- Ensure job roles and responsibilities emphasize a team-based approach to care and support each member of the team being trained to meet the highest level of function
- Performs other duties as assigned.
QUALIFICATIONS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
EDUCATION/EXPERIENCE and SKILLS:
- A High School diploma or equivalent is required.
- Two years Medical (or related) Office Management and supervising experience (e.g., management in a health care setting, customer service, etc.) and/or training; or equivalent combination of education and experience.
- Bachelor's Degree, PCMH CCE and CPPM are required.
- Understanding of the medical insurance process.Previous experience with medical terminology and
- Must be able to understand or quickly learn about the differences between and among patients with private insurance, Medicare, Medicare Advantage, Workers’ Compensation, and self-paying patients, etc.
- The employee performing this position is expected to:
- Respond courteously, sympathetically, and maturely to patient needs.
- Be detail-oriented, well organized, and computer literate (i.e., be familiar with a multiline phone system, PC and basic software, such as Microsoft Windows, Excel, Microsoft Word, etc.).
- Become a superuser on the practice’s electronic medical record, Epic.
- Be able to work under pressure and in stressful situations and must be able to work quickly when business conditions warrant.
CONDITION OF EMPLOYMENT:
Due to the state mandate for Healthcare Workers, we will require you to prove that you have received the COVID-19 vaccine or have a valid religious or medical reason not to be vaccinated.
Montage Medical Group
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