Medical Referral Clerk (Winnetka)

POSITION: Medical Referral Clerk

RESPONSIBILITIES: This position reports to the Clinic Administrator. S/he will process all HMOs, Medi-Cal, Medicare and My Health LA (MHLA) referrals. S/he will enter data to generate authorization numbers. Present prospective and retrospective referrals to the Utilization Review (UR) meeting. S/he will maintain required logs: prospective, retrospective, denial, etc. Submits required Utilization Management (UM) reports to the health plans in a timely fashion. Will coordinate with the Claims Adjudicator and Case Managers relating to patients referrals, claims or case management. Will coordinate with patients, Managed Care Dept., El Proyecto del Barrio (EPDB) providers, specialists, hospitals, and health plans on referral issues. S/he will assist providers and specialists with the referral process. Attends and actively participates in the UM meetings, in-services, and meetings requested by the Clinic Administrator. S/he will participate in and in the preparation of funding audits. Complies with EPDB UM/Quality Measures (QM) and health plans policies and procedures. S/he will conduct in-service trainings at each clinic site regarding the referral process, assists the Clinic Administrator in developing the Annual and Evaluation UM Program. Generates and reviews patients referral utilization reports. Will perform other assigned duties as requested.

For a Lead Medical Referral Clerk: S/he will be responsible for the supervision of other Medical Referral Clerks. The Medical Referral Clerk will participate in Quality Assurance (QA)/Quality Improvement (QI) and QM meetings.

REQUIREMENTS: Must possess good organization skills. Mature judgment, tact, discretion, and confidentiality are mandatory. Proficient in Microsoft Word and Excel. Understanding of medical terminology, CPT codes and ICD10. Position requires a professional, pleasant, and effective representation of the corporation. Bilingual (Spanish/English) preferred.

OTHER REQUIREMENTS: Must submit to and pass a drug test and a criminal background clearance as a pre-condition for employment. Must be able to provide proof of COVID-19 and booster, Hepatitis B, MMR, TDAP vaccinations and TB test. BLS/CPR certification required.

QUALIFICATIONS: High School Diploma OR GED. Must have at least one (1) year clerical experience in a medical setting OR general office work.

AN EQUAL OPPORTUNITY AFFIRMATIVE ACTION EMPLOYER