Kaiser Permanente Referral Coordinator - Continuing Care Services in Portland, Oregon
Under direct and indirect supervision evaluates, manages, analyzes, and processes referral requests for Continuing Care Services (CCS) to determine the appropriate program for the patient.
• Under direct and indirect supervision, analyzes and processes referral requests for CCS to assure they meet established program criteria.
• Receives and interprets referral requests, determines benefits and communicates this information to members, non-plan providers, NWP providers and other internal staff as appropriate.
• Coordinates communications from contracted and non-contracted vendors related to the admission of KP members.
• Contacts patients regarding receipt of referral and provide brief explanation of CCS programs, verify demographics and benefit information, and facilitates patient agreement to receive services from designated programs.
• Processes non-clinical aspects of referrals to CCS including, insurance coverage, physician verification of NPI and PECOS, hospice attending physician, case assign clinicians, coordinates start of care date within each program’s regulatory requirements.
• Effectively maintains daily accurate records of referrals to ensure patients are admitted to services in a timely manner.
• Serves as a liaison between referring and program physicians, patients/families, department supervisors, managers, and CCS staff to ensure timely patient care.
• Identifies and assists with timely transitions across programs.
Under direct and indirect supervision, processes non-clinical aspects of referrals for CCS, Salem, Longview, and when programs are at capacity or require referral outsourcing.
• Provides initial authorization when patients are outsourced.
• Establish spot contracts when patients are outsourced to a non-core agency/facility.
• Communicate effectively to ensure that patients referred out to outside agencies get care timely.
• Provide patient information when requested by outsourced agencies.
• Perform other duties as requested.
• Minimum three (3) years demonstrated Medicare regulation experience pertaining to home care and facility care or equivalent experience.
• Minimum one (1) year of demonstrated insurance and benefit plan experience.
• High School Diploma or General Education Development (GED) required.
License, Certification, Registration
• Knowledge of Home Health and Hospice Medicare Conditions of Participation, The Joint Commission standards, Washington Administrative Code and Oregon Administrative Regulations.
• Ability to work independently with indirect supervision, assimilates technical information, and maintains effectiveness in a busy environment.
• Effective problem solving, analytical, and organizational skills as evidenced by past performance recognition.
• Working knowledge of office machines, including PC-based computer systems (Windows), word processing, spreadsheet applications, data base applications.
• Demonstrates excellent communication and customer-focused service skills as evidenced by past performance recognition.
• Good written and verbal skills.
• Thorough knowledge of medical terminology.
• Minimum three (3) years processing referrals in home care or facility care.
• Thorough knowledge of KP organization and structure.
• Thorough knowledge of continuous process improvement principles, tools, and practices.
• Working knowledge of KP computer systems including Healthconnect, common membership, and Tapestry.
- Variable shifts/days/weekends/holidays
TITLE: Referral Coordinator - Continuing Care Services
LOCATION: Portland, Oregon
External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.