What are the responsibilities and job description for the Referral Authorization Coordinator (RHC) position at Paskenta Band of Nomlaki Indians?
Brief Description
Position Summary
The Referral and Authorization Coordinator is responsible for compiling, processing, and maintaining electronic and traditional medical records for clinic patients in accordance with medical, administrative, ethical, legal, and regulatory standards. This position works directly with Paskenta Nomlaki Tribal Members, providers, and healthcare facilities to efficiently coordinate referrals and obtain authorizations. The role requires careful handling of sensitive medical information and strict adherence to HIPAA and clinic procedures.
Essential Duties/Responsibilities
Required Education & Experience
Working Environment: Work is performed in a health clinic setting. The noise level in the work environment is usually low to moderate. Will work with blood-borne pathogens and will require OSHA training. This job routinely uses standard office equipment such as computers, telephones, photocopiers, and fax machines. The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to talk and listen. The employee frequently is required to stand, walk, sit, use hands to finger, handle, or feel; and reach with hands and arms. The employee is occasionally required to stoop. The employee must occasionally lift and/or move up to 50 pounds. Position may require exertion up to 20 pounds of force occasionally and/or up to 10 pounds of force frequently or constantly lift, carry, push, pull or otherwise move objects. Specific vision abilities required by this job include close vision, distance vision, color vision peripheral vision, depth perception and ability to adjust focus.
Other Requirements Of Employment
Background Check Requirements:
Pre-employment Drug Testing and a Department of Justice Fingerprinting clearance through Federal, State and Child Abuse Index is a contingency for an offer of employment. Criminal clearances are obtained to protect the welfare and safety of clients receiving services at Rolling Hills Clinic.
Vaccination Requirements
Provide vaccination records to show proof of immunity for TB, Measles, Mumps, Rubella, Varicella, TDAP & Hep B. If the records are more than 10 years old, titers are required to confirm immunity.
"Native Preference in hiring is given to qualified enrolled members of Paskenta Band of Nomlaki Indians and Native Americans in accordance with the Band’s Preference Policy (Chapter 1-715 of the Paskenta Band of Nomlaki Indians Tribal Policies). Applicants claiming Indian Preference must submit verification of Indian certified by tribe of affiliation or other acceptable documentation of Indian heritage.”
Employment with Rolling Hills Clinic is voluntarily entered into. All RHC personnel are employed on an at-will basis. At-will employment may be terminated with or without cause, and with or without notice at any time by the employee or by RHC. No manager, supervisor, or employee of the organization has any authority to enter into an agreement for employment for any specified period of time or to make an agreement for employment other than at-will terms. The job description does not constitute an employment agreement between Rolling Hills Clinic and employee and is subject to change by the Paskenta Band of Nomlaki Indians.
Position Summary
The Referral and Authorization Coordinator is responsible for compiling, processing, and maintaining electronic and traditional medical records for clinic patients in accordance with medical, administrative, ethical, legal, and regulatory standards. This position works directly with Paskenta Nomlaki Tribal Members, providers, and healthcare facilities to efficiently coordinate referrals and obtain authorizations. The role requires careful handling of sensitive medical information and strict adherence to HIPAA and clinic procedures.
Essential Duties/Responsibilities
- Answer questions about Rolling Hills Clinic and Tribal Member Support Department, providing accurate information.
- Offer assistance with the patient portal and other healthcare requests.
- Verify patient demographics for every patient and keep all records, forms, and data files updated in the Electronic Medical Record and other systems.
- Protect the confidentiality and security of medical records (HIPAA).
- Work independently to complete daily duties requiring minimal supervision.
- Provide and accept feedback professionally; communicate clearly in both individual and group settings.
- Handle inbound inquiries regarding referrals/prior authorizations, screening requests per benefit plan, insurance, clinical criteria, and patient needs.
- Process and follow-up all incoming and outgoing referrals and authorizations promptly per RHC guidelines; consistently communicate updates and document all interactions.
- Maintain organized records of all requests and update the Electronic Medical Record and tracking spreadsheets.
- Maintain a high level of customer service, professionalism, attention to detail, emotional intelligence, and listening skills.
- Demonstrate proficiency with computer systems, technology, and office equipment.
- Maintain compliance with ergonomic safety standards, including regular posture checks and stretches.
- Ensure optimal safety and health practices for self and others at all times; take corrective action on any safety concerns.
- Must have the ability to relate and communicate effectively with community interest groups, agencies, and medical facilities that serve the American Indian Community.
- Participate in mandatory in-service programs and assigned committees.
- Maintain punctuality, reliability, and attendance standards.
- Performs other duties as assigned.
Required Education & Experience
- Must be at least 18 years of age.
- High school diploma or equivalent.
- At least one (1) year working in a medical facility.
- Associate's or Bachelor's degree in a related field such as health information management, medical office administration, or healthcare.
- Valid BLS Certification
- Valid California Driver’s License
- Pre-employment drug testing.
- Department of Justice fingerprint clearance through Federal, State, and Child Abuse Index.
Working Environment: Work is performed in a health clinic setting. The noise level in the work environment is usually low to moderate. Will work with blood-borne pathogens and will require OSHA training. This job routinely uses standard office equipment such as computers, telephones, photocopiers, and fax machines. The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to talk and listen. The employee frequently is required to stand, walk, sit, use hands to finger, handle, or feel; and reach with hands and arms. The employee is occasionally required to stoop. The employee must occasionally lift and/or move up to 50 pounds. Position may require exertion up to 20 pounds of force occasionally and/or up to 10 pounds of force frequently or constantly lift, carry, push, pull or otherwise move objects. Specific vision abilities required by this job include close vision, distance vision, color vision peripheral vision, depth perception and ability to adjust focus.
Other Requirements Of Employment
Background Check Requirements:
Pre-employment Drug Testing and a Department of Justice Fingerprinting clearance through Federal, State and Child Abuse Index is a contingency for an offer of employment. Criminal clearances are obtained to protect the welfare and safety of clients receiving services at Rolling Hills Clinic.
Vaccination Requirements
Provide vaccination records to show proof of immunity for TB, Measles, Mumps, Rubella, Varicella, TDAP & Hep B. If the records are more than 10 years old, titers are required to confirm immunity.
"Native Preference in hiring is given to qualified enrolled members of Paskenta Band of Nomlaki Indians and Native Americans in accordance with the Band’s Preference Policy (Chapter 1-715 of the Paskenta Band of Nomlaki Indians Tribal Policies). Applicants claiming Indian Preference must submit verification of Indian certified by tribe of affiliation or other acceptable documentation of Indian heritage.”
Employment with Rolling Hills Clinic is voluntarily entered into. All RHC personnel are employed on an at-will basis. At-will employment may be terminated with or without cause, and with or without notice at any time by the employee or by RHC. No manager, supervisor, or employee of the organization has any authority to enter into an agreement for employment for any specified period of time or to make an agreement for employment other than at-will terms. The job description does not constitute an employment agreement between Rolling Hills Clinic and employee and is subject to change by the Paskenta Band of Nomlaki Indians.