Patient Services Coordinator

Full Job Description

The County of Riverside – Riverside University Health System (RUHS) – CHC Jurupa Valley Division is seeking a detail-oriented and experienced Patient Services Coordinator with a strong background in medical insurance and prior authorization processes.

The ideal candidate will have hands-on experience verifying patient benefits, obtaining prior authorizations for medical procedures or medications, and working directly with insurance providers to ensure timely and accurate approvals.

Under minimal supervision, performs a variety of administrative and clerical duties in support of the Riverside University Health System (RUHS) Managed Care or Care Management program, secures authorization for services, completes patient assessments for eligibility criteria; and performs other related duties as required.

The Patient Services Coordinator will be primarily responsible for coordinating referrals generated with contracted Managed Care Plans, both public and private.

In addition, this class coordinates with physicians and mid-level providers regarding patient care or IPA's for all patients scheduled for appointments at RUHS, and obtains all authorizations necessary for patient care.

Main duties include but are not limited to the following:

• Case management duties
• Submitting and obtaining authorization services which includes clinic visits, specialty visits, outpatient surgeries and eConsults
• Liaison between healthcare staff and patients regarding maintenance of care and treatment
• Daily intake and outbound calls to input data into EMR and verify member eligibility
• Customer service and tracking of pending referrals
• Ensuring correct CPT and ICD-10 codes are valid
• Submits/Obtains authorization from the payer
• Running eligibility
• Manages ED and Inpatient discharges
• Procures authorization
• Incoming/Outbounds calls

The most competitive candidates will have the following experience:

• Care coordination with patients
• Communication skills/ team player
• Authorization, insurance and eligibility experience
• Strong customer service skills
• Clinical background
• Bilingual

Work Schedule: Will be discussed during the interview. (Tentative: 9/80, NON-Payday Friday off)
Work Location: : 8876 Mission Blvd. Jurupa Valley CA 92509

Meet the Team! Riverside University Health System provides a wide range of primary and specialty care services across 13 Community Health Centers (CHCs) throughout Riverside County.

As federally qualified health centers, the CHCs operate on a sliding fee scale to ensure that some of the county’s most vulnerable populations receive the care they need.

Whether it’s preventive care, chronic disease management, Express Care, Mobile Health, or integrated specialty and behavioral health services, our teams are made up of dedicated healthcare professionals who are passionate about making a difference.

If you’re committed to delivering compassionate care and eager to join a team that truly values community, connection, and making a meaningful difference, RUHS is the place for you!

Learn more about our Community Health Centers by visiting www.ruhealth.org

Requirements

• 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.

Qualifications

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.

Requires a valid California driver’s license for participation in mandated trainings and off-site meetings.

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.

Additional Information

For further information regarding this posting, contact the recruiter: Anay Sanchez at anasanchez@rivco.org or call 951-955-5893. Due to the high volume of calls, please allow up to 2 business days to receive a response.