Job details

Care Connection Associate, Full Time, 8-Hour Day Shift, Hanford Care Connection Call Center

Adventist Health Reedley, is one of four medical centers that forms Adventist Health in the Central Valley, consisting of 4,000 associates and providers. This medical center serves the communities of southern Fresno County and northern Tulare County. It provides the following care services: emergency, Inpatient and outpatient surgery, wound care, and birthing services which include a 24-hour tele-neonatologist and pediatricians in partnership with Valley Children's Hospital.

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, including, but not limited to, measles, mumps, flu (based on the seasonal availability of the flu vaccine typically during October-March each year), COVID-19 vaccine (required in CA, HI and OR) etc., as a condition of employment, and annually thereafter. Medical and religious exemptions may apply.