Patient Services Coordinator (Finance)

Riverside University Health System - Medical Center is seeking a Patient Services Coordinator to support the management of patient referrals and facilitate seamless coordination of specialty care visits. Depending on the assignment area, the Patient Services Coordinator reports to the Nurse Coordinator, Director of Nursing Services, or the appropriate Revenue Cycle Manager.

The primary responsibility of the Patient Services Coordinator is to coordinate patient care within RUHS ambulatory clinics and manage referrals associated with contracted public and private Managed Care Plans. This role also involves collaborating closely with physicians, mid-level providers, and Independent Practice Associations (IPAs) to ensure effective coordination of care for all patients scheduled for appointments at RUHS. Additionally, the coordinator is responsible for obtaining all necessary authorizations required for patient care.
Work Schedule: 5/40 Monday - Friday - remote
Site Location(s): Moreno Valley/Riverside
The Ideal Candidate will have:

• Comparable experience processing insurance referrals for authorization and knowledge of insurance payers
• The ability to work independently
• Significant computer proficiency for telecommuting
• Strong multi-tasking and prioritization skills to handle the heavy volume of referral processing
• Strong customer service skills

About RUHS
Riverside University Health System (RUHS) is a large county health system that includes the Medical Center and main campus specialty clinics, Community Health Centers, and the Departments of Behavioral and Public Health. To learn more about RUHS's efforts to support some of the region's most vulnerable patient populations, please visit their websites:
RUHS YouTube channel
RUHS website• Assist physicians and other healthcare providers by providing care coordination to ensure patients receive optimal care; interact with Primary Care Providers, Specialty Providers, and other healthcare staff to coordinate care for patients.

• Liaison between healthcare staff and patients regarding maintenance of care and treatment; work closely with Providers to ensure continuity of care and treatment; facilitate communication among patients, physicians, nurses, and other healthcare staff regarding their care, including making appointments, treatment authorizations and resource needs.

• May assist with patient referrals to appropriate community resources; may provide patient education.

• Daily management of referrals which includes, input of data into manage care system, verify member eligibility, provider participation, and tracking of pending referrals.

• Authorize Treatment Authorization Requests (TAR) for the County of Riverside Medically Indigent Services Program (MISP); coordinate Durable Medical Equipment (DME) for all Managed Care Health Plans, public and private, coordinating quotes and equipment availability.

• Assist with transfer of patients to and from RUHS Medical Center and Care Clinics and other outlying hospitals for specialized care; verify patient eligibility with associated health plans.

• Coordinate with contracted IPA's and return copies of all appropriate clinic, surgery, and emergency room progress notes; process and authorize all requests for pharmacy that are not covered in the Drug Formulary.

• Request and review all emergency room notes for managed care patients that are seen through the Emergency Department; ensure return of all notes (i.e., outpatient, surgical, and emergency) to appropriate PCP or IPA.

• Coordinate patient transfers to other facilities for higher-level of care; coordinate with Medical Social Workers to facilitate care for patients; assist patients in qualifying for Medi-Cal or other programs.

• Process Third Party claims by determining and supplying information to and from attorney respective of patient's eligibility at the time of an accident.Education: Graduation from high school or possession of a Certificate of Proficiency issued by the California State Board of Education, or attainment of a satisfactory score on a G.E.D. test.

Experience: Three years of increasingly responsible, broad and varied clerical experience, at least one year of which included working in a managed care, healthcare, or behavioral health setting. For the RUHS care management program, experience as a Licensed Vocational Nurse or experience equivalent to the County of Riverside Behavioral Health Specialist I class is preferred.

Knowledge of: Rules and regulations pertaining to the confidentiality of medical information from federal, state and county agencies; medical terminology and basic laws of healthcare facilities and hospitals; federal, state and county regulations related to healthcare compliance.

Ability to: Interpret medical information, diagnosis and apply medical guidelines; communicate effectively orally and in writing; maintain effective working relationships with a wide variety of individuals; work independently, as well as in a team environment; operate a variety of telephone technology systems; understand the capabilities and applications of information processing equipment, considering the requirements of the program; utilize motivational interviewing skills; work efficiently in a fast paced environment; provide excellent customer service.BASED ON THE NUMBER OF APPLICATIONS RECEIVED, THIS POSTING MAY CLOSE WITHOUT NOTICE.

For specific questions regarding this position, contact Angela Levinson at alevinson@rivco.org or 951-955-5562.