This position is responsible for accurately and timely completing and tracking both internal and external referrals. This position acts as a liaison and scheduling assistant between CL Brumback Primary Care Clinics and the referred to entity, and is accountable to ensure appropriate authorizations for referred services, both in and out of network.

Our 10 Federally Qualified Health Centers across the county serve adults and children with or without insurance and regardless of ability to pay. We also operate three mobile clinics that provide medical services for the homeless and the underserved. In 2022, we served 39,000 unique adult and pediatric patients who received high-quality comprehensive health services including medical, dental, behavioral health, psychiatric care, women’s health, pharmacy services, outpatient substance use disorder treatment, and community resource programs.

• Analyzes health service requests for accuracy and completeness of information based on referral guidelines.
• Assemble required information concerning patient's clinical background and referral needs. Per referral guidelines, provide appropriate clinical information to Registration Specialist.
• Contact internal department, external organization, or insurance company, as appropriate, to ensure prior authorization requirements are met, if required. Present necessary medical information such as history, diagnosis and prognosis, as needed.
• Reviews details and expectations about the referral with the patient. Assist patients in problem solving potential issues related to the health care system, financial or social barriers (e.g., request interpreters as appropriate, and transportation services.
• Follow-up on pending referrals and send certified letters to non-compliant patients.
• Keep current update to Clinics Contacted Insurance Listing in order to facilitate referral and authorization processing.
• Establish and maintain relationships with identified service providers.
• Verifies participation and contracted provider status.
• Prioritizes health service requests in order to meet 72-business hour turnaround standard.
• Inputs member and authorization information into the current operating system. Maintains ongoing tracking of referrals through completion.
• Troubleshoots calls from providers concerning authorizations and explanations of benefits.
• Maintains and updates comprehensive knowledge of medical terminology.
• Ensures adherence of patient confidentiality and HIPAA compliance on all documentation and maintains secure recordkeeping.
• Responsible for answering phone calls in a timely, professional and courteous manner.

• High school diploma or GED required.
• Three (3) to five (5) years experience in a physician’s office, healthcare, or insurance company setting, that demonstrates knowledge of medical terminology, coding, billing and customer service. Must have basic computer skills and experience with keying claims or authorizations.