Skip to Main Content

Referrals and Authorizations Manager

Montage Medical Group Monterey, CA

  • Expired: over a month ago. Applications are no longer accepted.
Job Description
 
Montage Medical Group (MMG), a subsidiary of the Montage Health system, operates as a licensed community clinic following California Department of Public Health Title 22 statutes. MMG launched in 2009 with a clinic in Carmel and now serves Monterey County through several clinics located in Carmel, Marina, and Monterey. MMG is a non-profit public service physician group with over 60 healthcare providers, seeing approximately 125,000 patient visits annually. We believe the primary motivators for healthcare workers are a deeply held yearning to make a difference, to find meaning in all life experiences – good and bad – an innate human need to be engaged with honorable and talented people doing important work so that, in the end, they could say, “I made a difference in people’s lives.”
We foster the ongoing employment and development of employees who share our guiding philosophy, are engaged in their workplace, and are accountable for their choices and outcomes.


SUMMARY:
The person in the position of the Referrals and Authorizations Manager must be able to perform the duties described within as well as to meet the company’s qualifications regarding education, experience, patient service, attitude, language skills, meet physical requirements, possess mathematical and computer skills.  He/she must be able to read and write and to use logical reasoning ability as well as to be able to follow the direction of upper management.


SUPERVISORY RESPONSIBILITIES:
Direct management responsibility Human Resources department which including the Orientation Specialists. Carries out management responsibilities in accordance with the organization's policies and applicable laws.


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

Address

Monterey, CA
93940 USA

Industry

Business

View all jobs at Montage Medical Group