Stanford Children's Health - Lucile Packard Children's Hospital
Location: Palo Alto, California
Internal Number: 9955886
1.0 FTE, 8 Hour Day Shift
At Stanford Children's Health, we know world-renowned care begins with world-class caring. That's why we combine advanced technologies and breakthrough discoveries with family-centered care. It's why we provide our caregivers with continuing education and state-of-the-art facilities, like the newly remodeled Lucile Packard Children's Hospital Stanford. And it's why we need caring, committed people on our team - like you. Join us on our mission to heal humanity, one child and family at a time.
This paragraph summarizes the general nature, level and purpose of the job.
The Intake Referral Representative is responsible for handling all aspects of the authorization process and assists with front office responsibilities. Gathers appropriate and correct patient demographics, financial information, confirming correct health coverage, financial screening, worker compensation status, and noncovered services. Responsibilities include phone triage, refill intake, and Program Assistant support. Determines patient financial responsibility and preparing a written estimate for department services. Serves as an insurance and coding resource for business and clinical staff in the department.
The essential functions listed are typical examples of work performed by positions in this job classification. They are not designed to contain or be interpreted as a comprehensive inventory of all duties, tasks, and responsibilities. Employees may also perform other duties as assigned.
Employees must abide by all Joint Commission Requirements including but not limited to sensitivity to cultural diversity, patient care, patient rights and ethical treatment, safety and security of physical environments, emergency management, teamwork, respect for others, participation in ongoing education and training, communication and adherence to safety and quality programs, sustaining compliance with National Patient Safety Goals, and licensure and health screenings.
Must perform all duties and responsibilities in accordance with the Service Standards of the Hospital(s).
Accesses information in both Stanford Hospital and LPCH computer systems.
Accurately receives telephone refill orders and enters in computer tickler system after assessing the most efficient and cost effective mode of delivery.
Assists patients/families with insurance issues.
Determines patient financial responsibilities and prepares a written estimate to be made available to the pharmacist and RN caring for the patient.
Determines the correct ICD-9 and CPT codes for client services when necessary.
Documents clearly and accurately in the SP clinic computer system.
Enters patient demographic and insurance data into pharmacy computer system and makes charts.
Maintains knowledge of active contracts with insurance companies.
Obtain prior authorization/continuing authorization for CHP services for clients.
Tracks new referrals, volume, and statistics.
Verifies benefit information from insurance companies for Home Infusion, Enteral, Self-Injectible services for both adults and pediatric clients.
Works in close collaboration with the Reimbursement Department in facilitating claims.
Any combination of education and experience that would likely provide the required knowledge, skills and abilities as well as possession of any required licenses or certifications is qualifying.
Education: High school diploma or GED equivalent
Experience: One (1) year of progressively responsible and directly related work experience
Knowledge, Skills, and Abilities
These are the observable and measurable attributes and skills required to perform successfully the essential functions of the job and are generally demonstrated through qualifying experience, education, or licensure/certification
Ability to maintain confidentiality of sensitive information.
Ability to speak, read, write, and understand English effectively at a level appropriate for the safe and effective performance of the job.
Ability to work well with individuals at all levels of the organization.
Knowledge of computer systems and software used in functional area.
Knowledge of federal and state laws related to area of responsibility.
Knowledge of Medical Terminology.
Knowledge of Medicare, Medi-Cal, Workers Comp, Managed Care (HMO, PPO, POS, etc ), Children's Health Programs (CCS, GHPP, Healthy Families, etc ).
Physical Requirements and Working Conditions The Physical Requirements and Working Conditions in which the job is typically performed are available from the Occupational Health Department. Reasonable accommodations will be made to enable individuals with disabilities to perform the essential functions of the job.
Equal Opportunity Employer
Lucile Packard Children's Hospital Stanford strongly values diversity and is committed to equal opportunity and non-discrimination in all of its policies and practices, including the area of employment. Accordingly, LPCH does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements, and where applicable, in compliance with the San Francisco Fair Chance Ordinance.