Area of Interest Utilization/Quality Management Position Type Full-time Work schedule: After hours 12 pm-12 am and Every other weekend 12 pm-12 am Position Summary: The After Hours Transfer Coordinator supports the process that manages the Afterhours Call Department. The goal for this position is to effectively support the Afterhours Call Services management process by assuring the right information is provided timely to the team. This includes ensuring that all necessary clerical functions are completed accurately and timely. Assist in facilitating referrals, transfers, and authorizations. Relates and communicates well over the telephone to all callers. Essential Duties and Responsibilities include the following: Receives and responds to telephone calls from members and providers. Verifies eligibility and benefits and communicates to the nurse. Generates authorizations for hospitals, vendors, and/or outside services as directed. Receives and responds to telephone calls from hospitals, vendors, and physicians requesting facilitation of requested services. Directs caller to appropriate Triage nurse. Documents all calls according to established standards. Translates oral information into concise and accurate written documentation. Demonstrates customer service-oriented behavior at all times. Accesses Language Line for non-English speaking patients as needed. Participates in regular staff meetings as scheduled. Uses, protects, and discloses patients' protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards. Consistently exhibits behavior and communication skills that demonstrate commitment to superior customer service, including quality, care, and concern with each and every internal and external customer. Ensures all approved authorizations are entered accurately into the system. Maintains accurate and timely records in REA. Scans physician progress notes, reports, and records and attaches documents to appropriate authorizations. Updates and closes cases in a timely manner. Communicates immediately any admissions to non-contracted or non-core facilities. Distributes face sheet immediately upon receipt and eligibility check to the appropriate nurse. Checks all new admissions for Out of Area status. Reviews case statuses to ensure proper documentation and case closure. Works with assigned nurse to complete all documentation. Communicates with supervisor regarding any potential issues. Prepares appropriate denial letter at the direction of the Nurse. Maintains confidentiality of all patients and medical/clinical information. Identifies network needs and reports to management for potential contracting opportunities. Monitors incoming fax server and flags each fax appropriately to ensure proper routing. Acts as a mentor as requested by supervisor. All other duties as directed by management. The pay range for this position at commencement of employment is expected to be between $18 - $20 per hour; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience. The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered. Details of participation in these benefit plans will be provided if an employee receives an offer of employment. If hired, employee will be in an “at-will position” and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors. As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare&Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming, and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel because we believe that your success is our success. Full Time Position Benefits: The success of any company depends on its employees. For us, employee satisfaction is crucial not only to the well-being of our organization but also to the health and wellness of our members. As such, we are firmly dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy balance between work and life. Our dedication to our staff is evident in our comprehensive benefits package. We offer a very generous mixture of benefits, including many employer-paid options. Health and Wellness: Employer-paid comprehensive medical, pharmacy, and dental for employees. Vision insurance. Zero co-payments for employed physician office visits. Flexible Spending Account (FSA). Employer-Paid Life Insurance. Employee Assistance Program (EAP). Behavioral Health Services. Savings and Retirement: 401k Retirement Savings Plan. Income Protection Insurance. Other Benefits: Vacation Time. Company celebrations. Employee Assistance Program. Employee Referral Bonus. Tuition Reimbursement. License Renewal CEU Cost Reimbursement Program. Business-casual working environment. Sick days. Paid holidays. Mileage. Employer will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance. Requirements Education and / or Experience: Education/Training High school diploma or general education degree (GED). Experience 1 year related experience preferred. Skills Good judgment and critical-thinking skill. Compassionate and caring manner with patients. Telephone “charisma”. Forms instant rapport. Customer service–oriented. Helpful, warm, open, and inviting. Excellent communication skills (written, verbal, and technical). Articulate. Able to communicate well at fifth- to eighth-grade level. Bilingual language skills a plus. Proven typing skills at 40 words per minute with accuracy. Knowledge of computers, faxes, printers, and all other equipment. Proficient in MS Office programs (i.e., Word, Excel, Outlook, Access, and Power Point). Attributes Functions well in a high-stress environment and under time pressure. Works effectively with: Culturally diverse populations. Educationally diverse and illiterate populations. Non-English-speaking populations. J-18808-Ljbffr