Temporary Patient Services Coordinator (Finance)

The Patient Services Coordinator plays a crucial role in managing patient care at RUHS ambulatory clinics and overseeing referrals with contracted Managed Care Plans. This position involves close collaboration with physicians and mid-level providers to secure authorizations, verify eligibility, and navigate insurance requirements. Proficiency in diagnosis and procedure codes, referral processing, and authorization submission is essential.
Responsibilities include obtaining authorizations for clinic visits, specialty consultations, outpatient surgeries, and eConsults, while serving as a liaison between healthcare providers and patients to ensure continuity of care and treatment. The coordinator also handles daily intake and outbound calls, entering data into EMR systems, verifying patient eligibility, and tracking pending referrals.
Key Duties:

• Ensuring accuracy of CPT and ICD-10 codes
• Submitting and securing payer authorization
• Running eligibility checks
• Managing ED and inpatient discharges
• Procuring necessary authorizations
• Handling incoming and outbound calls

Ideal candidates are fast learners, capable of multitasking, possess strong computer proficiency, and exhibit critical thinking and independent work ethic. Excellent customer service skills are a must, with a preference for individuals with at least two years of authorization experience.

Spanish speaking preferred, but not required.

Working hours: 5/40 (Mon.-Fri 8am-4:30pm)

Meet the Team!
Riverside University Health System

TAP Benefits: Reasons to work for the County of Riverside - flipbook

https://issuu.com/rivcohr/docs/hr_flipbook_1-24-23_r3• 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.Recruiting Guidelines

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.

Other Requirements

Skills: Computer literate; ability to type 40 wpm.

License/Certificate: Possession of a valid California Driver's License will be required.
Pre-Employment

All employment offers are contingent upon successful completion of both a pre-employment physical exam, including a drug/alcohol test, and a criminal background investigation, which involves fingerprinting. (A felony or misdemeanor conviction may disqualify the applicant from County employment.)

Probationary Period

As an Approved Local Merit System, all County of Riverside employees, except those serving "At Will," are subject to the probationary period provisions as specified in the applicable Memorandum of Understanding, County Resolution, or Salary Ordinance. Temporary and Per Diem employees serve at the pleasure of the agency/department head.Other Requirements:
License/Certificate: Possession of a valid California Driver's License will be required.

What's Next?
This recruitment is open to all applicants. Applicants who are current employees of the Riverside University Health System may be considered before other applicants depending on the volume of applications received.

Qualified applicants may be considered for future vacancies throughout the County.

BASED ON THE NUMBER OF APPLICATIONS RECEIVED, THIS POSTING MAY CLOSE WITHOUT NOTICE.

Applications received prior to the closing date will be considered based on the information submitted. Changes or alterations cannot be accepted. No late applications will be permitted.

Include relevant work experience details on resume and/or application.

Applicants who fail to provide information demonstrating they possess the position requirements may not be considered further in the application process. A description of job duties directly copied from the job classification or job posting will not be considered.

Upload a copy of any license(s), official/unofficial transcript(s), degrees, and/or related employment documents to your NeoGov account. If your education was completed outside of the United States, you will need to provide a copy of your Foreign Education Equivalency evaluation from a member of the National Association of Credential Evaluation Services or ( NACES ) Association of International Credential Evaluators, Inc. ( AIC ).

For questions regarding this recruitment:

Please contact Daniel Kimbrough at dkimbrough@rivco.org with any questions regarding this recruitment.