UCSD Layoff from Career Appointment: Apply by 03/16/2017 for consideration with preference for rehire. All layoff applicants should contact their Employment Advisor. Eligible Disability Counseling and Consulting services (DCC) or Special Selection clients should contact their Vocational Rehabilitation Counselor for assistance.
Under the general supervision of the AA III/HA IV and Practice/Nurse Manager, provides administrative referral service coordination functions to the clinic or department. Provides referral and authorization services to the benefit of the patient's medical necessities as directed by a physician(s). Provides direction to physicians, staff, and patients of authorizations allowed by health care plans.
Monitors and maintains all referral and authorization activity and utilizes methods to track progress of referrals and authorizations to meet office and health plan requirement and deadlines. Utilizes reports to indicate and track pertinent information. Serves as a liaison to health plans, departments, internal and external business offices, and other departments.
The incumbent will also maintain constant communication with department individuals and patients. Prepares reports, tracks data, and prepares presentations for clinic and department about referral activity protocols, health plan requirements and changes. Monitors compliance of requirements. Job standards are to be performed at the EXPERT level.
High school diploma, GED; or an equivalent combination of education, experience, skills, knowledge and abilities essential to the successful performance of duties assigned to position.
Previous registration/patient access/insurance verification experience in a large, complex healthcare setting.
Understands all insurance types (PPO's, Commercial, Point of Service, HMO's, Military, Medi-Cal, MediCare, Medical-Managed Care, etc.).
Possess a thorough working knowledge of third party insurance payors and Federal/State public programs.
Ability to multi-task, demonstrate proficiency in computer skills and exhibit excellence in written and verbal communication.
Must possesses superb customer service skills.
Ability to interact effectively with the public, including patients, visitors, clinical and support staff.
Knowledge of IDX, PCIS, EPIC.
Experience with all Family Medicine lines of business, including Acupuncture, Osteopathic Manipulation, Psychiatry, Sports Medicine, Obstetrics, CA Children's Services.
Experience with all UCSD contracted MCal referral processes, Government (TriCare) referral processes and knowledge of DME requirements.