Pacific Medical Centers Referral Coordinator - USFHP in Seattle, Washington
Find what you’re looking for in your career, at PacMed as a Uniformed Services Family Health Plan - Referral Coordinator (1.0 FTE, Day Shift) in Seattle, WA.
We are seeking a USFHP Referral Coordinator provides the administrative functions needed to support a smooth, efficient referral process.
In this position you will:
Review all referrals for eligibility and benefits and consults with the appropriate areas for clarification or assistance. Make coverage decisions based on PMC approval criteria or TRICARE policy and procedure as appropriate.
Assist with management of the referral process, which includes PMC processes and necessitates expertise in utilizing various computer systems; supports Patient Care Committees (PCC) by coordinating decisions and assuring appropriate information is entered into computer systems; coordinates the management of denials through collaboration with RNs; enters or completes data entry and Approval Status on IDX computer system; coordinates the processing of referrals and assures that all referrals are processed according to department, NCQA and URAC turnaround standards.
Perform data entry and filing, generate and distribute daily and weekly system UM reports.
Interacts with appropriate PMC staff to clarify referral information in order to determine benefits, research day-to-day problems
Reviews cases for possible third-party liability and brings to attention of Member Services for investigation
Required qualifications for this position include:
High school diploma or equivalent;
Two years’ experience in medical related field.
Previous experience in UR, health plan, or managed care environment.
Ability to frequently shift thinking and work processes between various lines of business, insurance plans, medical group practices and computer systems.
ICD9-CPT and DRG codes knowledge.
Medical terminology experience.
Preferred qualifications for this position include:
- Degree as LPN or health data services coordinator.
Pacific Medical Center :
Pacific Medical Center is an expanding network of outpatient clinics providing primary and specialty care to the greater Seattle area and employing more than 150 providers representing most medical specialties. Pacific Medical Centers is affiliated with Providence Health & Services, which operates 28 exceptional not-for-profit hospitals and more than 350 clinics across the West. With hundreds of physician and advanced practice provider opportunities in virtually all specialties at any given time, Pacific Medical Centers and Providence offer diverse locations, lifestyles and practice models. Find what you are looking for in your next practice opportunity with Pacific Medical Centers! Learn more at www.pacmed.org/providerjobs .
We offer a full comprehensive range of benefits — see our website for details —
Our mission is to provide respectful, high-quality, patient-focused healthcare to each person and to the communities we serve.
Quality and respect. These are the words Pacific Medical Centers (PacMed) employees live and work by. PacMed is a private, not-for-profit, primary and integrated multispecialty health care network with 10 outpatient clinics across the Puget Sound region and more than 175 primary and specialty care providers. Affiliated with the Providence Health & Services system, PacMed provides patient-focused health care — and even same-day appointments — to patients in King, Snohomish and Pierce counties. We provide immediate access to cutting-edge technology, first-class facilities and board-certified specialists, many of whom have been listed as among “Seattle’s Best Doctors.”
Pacific Medical Centers, PacMed, and their Affiliates' (collectively “PacMed”) comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, disability, or sex. PacMed does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
Job Category: Patient Services
Req ID: 287560