Supervisor, Care Connection - Clinic Overhead - RHC Call Center (Full Time, Day Shift)

Located in a tight-knit community in Kings County, Adventist Health Hanford has been serving the Central Valley since 1965. We are comprised of a 173-bed hospital and many outpatient clinics with primary and specialty care services. Hanford residents are proud of their city's historic charm and family-friendly atmosphere. Within an hour's travel time, Yosemite, Sequoia and Kings Canyon National Parks can be enjoyed.

Job Summary

Manages incoming and outgoing referrals from Imaging, primary and specialty providers in a timely and professional manner; schedules appointments according to practice policy; maintains positive relations with referral sources; schedules appointments from third party electronic referral systems, fax, email and web requests; and participates in marketing to referring practices.

Provides quality customer service & patient financial responsibilities to patients, referring physicians, visitors and internal customers by obtaining insurance authorization and benefit verification for imaging procedures and specialty referrals.

Job Requirements

Education and Work Experience

• High School Education/GED or equivalent: Preferred
• Associate’s/Technical Degree or equivalent combination of education/related experience: Preferred

Essential Functions

• Processes inbound and outbound referrals, verifies referrals are correctly ordered according to protocols in the EHR. Obtains benefit verification and necessary authorizations (referrals, pre-certification) prior to patient arrival for all ambulatory visits, procedures, injections and radiology services.
• Uses online, web-based verification systems and reviews real-time eligibility responses to ensure accuracy of insurance eligibility. Verifies patient demographic information and insurance eligibility including coordination of benefits; updates and confirms as necessary to allow processing of claims to insurance plans.
• Serves as navigator and point of contact for patients and families, with patients and families having direct access for asking questions and raising concerns. Occasionally assumes advocate role on the patient’s behalf with the carrier to ensure approval of the necessary supplies/services for the patient in a timely fashion. Assists patient in problem-solving potential issues related to the healthcare system, financial or social barriers (e.g., request interpreters as appropriate, transportation services or prescription assistance)
• Maintains satisfactory productivity rates and ensures the timeliness of referral and scheduling while maintaining work queue goals.
• Collaborates effectively with Care Connection Center associates and responds to provider (internal and external) and support staff questions, requests and concerns regarding the status of patient referrals, care coordination or follow-up status.
• Performs other job-related duties as assigned.

Organizational Requirements

Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply.

Adventist Health participates in E-Verify. Visit https://adventisthealth.org/careers/everify/ for more information about E-Verify. By choosing to apply, you acknowledge that you have accessed and read the E-Verify Participation and Right to Work notices and understand the contents therein.

About Us

Adventist Health is a faith-based, nonprofit, integrated health system serving more than 100 communities on the West Coast and Hawaii with over 440 sites of care, including 27 acute care facilities. Founded on Adventist heritage and values, Adventist Health provides care in hospitals, clinics, home care, and hospice agencies in both rural and urban communities.

Our compassionate and talented team of more than 38,000 includes employees, physicians, Medical Staff, and volunteers driven in pursuit of one mission: living God's love by inspiring health, wholeness and hope.