Providence St. Joseph Health

Job Information

St. Joseph Health / Covenant Health Patient Access Representative - Harrison Gastro in Eureka, California

We are looking for a Patient Access Representative for the HUM Harrison Gastro Department at St. Joseph Heritage Healthcare.

Location: Eureka, CA

Work Schedule: Full Time - 80 Biweekly Hours

Shift: 8-hour, Days

Job Summary:

Under minimal supervision, assists physician and other professionals in referral requests and patient placement, responds to all patient inquiries, referral and PCC materials. Correlates work assignments and daily activities with Supervisor and Manager.

Essential Functions:

  • Assist in the sorting and distribution of referrals within the department.

  • Responsible for all referral requests (HMO, EPO, PPO and Caloptima) to outside providers. Check eligibility, enrollment, benefits, etc. Process referral at authorized level.

  • Educates patient, physician and staff in HMO, PPO and Caloptima protocols and benefits.

  • Responsible for participation in, Quality Management, Utilization Management, and Peer Review Committee meetings.

  • May provide on-site support at satellite locations, as requested.

  • Generate, log and file assigned QM/UM reports within established deadlines.

  • Identify and communicates through established protocols, the trends/patterns that adversely impact flow.

  • Generate and track all patient and physician correspondence related to referrals.

  • Identify and communicate through established protocols, non-compliance with Utilization guidelines.

  • Completes disability forms for patients, as needed.

  • Responsible for the obtainment of all relevant materials and information to make informed referral decisions.

  • Timely response and appropriate communication with the SJHH- Customer Service Department for the quick and complete resolution of patient issues.

  • Research and initiate resolution of patient complaints, as appropriate (with in scope of knowledge and certification).

  • Assist as appropriate in health plan audits.

Skills:

  • Ability to work independently and self-prioritize workload.

  • Good organizational, documentation and communication skills.

  • Demonstrates dependability.

  • Must be able to work in a fast-paced department and handle multiple tasks, work with interruptions, and deal effectively with confidential information.

  • Exhibit courtesy/respect for co-workers; willing to help co-workers.

  • Bilingual English/Spanish communications skills preferred.

  • Must be able to type 45 WPM, accurately preferred.

  • Travel to other SJHH locations.

Minimum Position Requirements:

Education: H.S. Diploma or GED

Experience:

  • 1 year utilization experience in a managed care setting

  • Basic MS Word, Excel, and Windows experience.

License/Certification: Valid California Drivers License.

Preferred Position Qualifications:

Experience:

  • 3 years experience in a managed care setting.

  • Intermediate level of MS Word, Excel, and Windows experience.

  • IDX experience.

Mission Heritage Medical Group is one of California's most respected medical groups. With over 3,000 employees and 75 locations throughout California, including, Northern California, Orange County, High Desert and Los Angeles County, Mission Heritage Medical Group has been continually recognized as a leader in quality, customer service and information technology. This kind of success is the result of team work, a commitment to excellence and a strong adherence to the organization's mission, vision and values. Mission Heritage Medical Group provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Mission Heritage Medical Group complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

Company: Heritage Healthcare

Category: Administrative (Clinical)

Req ID: R335542

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