• Manage back-office responsibilities including referral management, prior authorizations, specialty pharmacy & infusions, and medical records to help deliver and implement clinical strategies and support member care coordination in collaboration with a multidisciplinary clinical team • Use a high level of attention to detail, organization, and communication skills to obtain, manage, and follow up on member referrals and prior authorizations to ensure key care plan goals are met

Role Description We are seeking an experienced Bilingual Referral Coordinator to join our healthcare team. The ideal candidate has a strong background in referral coordination, insurance authorization processes, and patient care coordination. This role requires excellent organizational and communication skills to ensure patients are seamlessly referred to specialists, surgery centers, and hospitals while maintaining compliance with payer requirements. Philippines-based bilingual candidates are preferred; however, qualified bilingual candidates from other locations will also be considered. The ideal candidate is detail-oriented, proactive, and able to manage multiple referrals simultaneously while providing excellent service to patients and healthcare partners. They should be comfortable working in a fast-paced environment, coordinating with multiple stakeholders, and ensuring referrals and authorizations are completed accurately and efficiently. Qualifications - Fluent in English and Spanish (spoken and written). - Previous experience as a Referral Coordinator in a medical practice. - Hands-on experience submitting prior authorizations for procedures. - Experience coordinating referrals with specialists, surgery centers, and hospitals. - Experience processing outpatient referrals. - Working knowledge of Medicare (required). - Working knowledge of Medical/Medicaid (required, as applicable). - Working knowledge of HMO, PPO, and other commercial insurance plans. - Working knowledge of California insurance guidelines and referral processes (required). - Required experience using Athenahealth EMR. - Strong understanding of insurance verification, referrals, and authorization workflows. - Excellent communication, organization, and time management skills. - Ability to manage a high-volume workload while maintaining attention to detail. Preferred Qualifications - Philippines-based bilingual candidates preferred. - Experience working in multi-specialty or outpatient medical practices. - Strong customer service and patient communication skills. Requirements Please note that this is a full-time contractor position (40 hours per week) with a negotiable pay rate depending on skillset and experience. The schedule is Monday through Friday, from 8 AM to 5 PM PST.

• Provide internal support to the Medical Management Department in the areas of Outpatient Case Management ensuring all services referred are reviewed according to plan requirements and approved criteria. • Effectively communicates to management and internal departments timely. • Receives and responds to all incoming calls from PCP, specialists, and other providers regarding inpatients, surgeries, and outpatient services including DME, Home Health Care, and other services requiring a pre-authorization. • Coordinates DME with contracted HMO vendors for outpatient services. • Coordinate with Inpatient Case Manager on discharge planning of members (DME, Home Health, and Skilled Nursing). • Coordinates and reviews retro surgical procedures with Manager. • Understands Health Plan policies and procedures regarding pre-authorization, benefits by health plan, and preferred facilities within each plan. • Enters data and coordinates elective admissions with a surgical component. • Maintains compliance with all health plan guidelines on the reporting of cases/surgeries. • Works with clinical staff to assess benefit levels for non-medical denial determination to ensure the denial process includes letter and log maintenance. • Identifies potential stop-loss candidates to be monitored and reports to a senior-level manager. • Applies Innovista guidelines and additional approved criteria as detailed in the client UM Plan for the length of stay/admission criteria to approve initial and continued inpatient services. • Other duties as assigned.

• Performs a wide range of administrative duties to include referral processing, patient registration. • Verification of benefits and insurance authorizations. • Patient appointment scheduling and communication with referral sources. • Maintains ongoing tracking and appropriate documentation on referrals to promote team awareness and ensure patient safety. • Ensures complete and accurate registration, including patient demographic and current insurance information. • Assembles information concerning patient's clinical background and referral needs. • Provides appropriate clinical information to specialist based on referral guidelines. • Contacts review organizations and insurance companies to ensure prior approval requirements are met. • Presents necessary medical information such as history, diagnosis, and prognosis. • Provides specific medical information to financial services as appropriate to process referral. • Reviews details and expectations about the referral with patients. • Assists patients in problem solving potential issues related to the health care system, financial or social barriers. • Acts as a system navigator and point of contact for patients and individuals who have consent and direct access to patient information.