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Job Field: Office Jobs
Location: Central Valley, CA
Salary: $Not stated

JOB SUMMARY:

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<tr><td valign="top" width="450"><b>Title: PPO Coordinator-Patient Financial Services*Location: California-Central Valley-ModestoOther Locations: California-Central Valley-ModestoPPO Referral Coordinator is a consultant, liaison and facilitator for the provider, hospital, insurance company and patient. Must obtain authorization for all procedures as required.Sutter Gould Medical Foundation (SGMF)is a non-profit, multi-specialty health care organization affiliated with Sutter Health. Based in Modesto, SGMF provides quality medical care, health education and research activities in a five-county area. SGMF''s medical staff includes family practitioners, internists and pediatricians, as well as a range of specialist physicians. Services include imaging, nuclear medicine, a health library, health education programs, occupational medicine, diabetes education, nutrition counseling, infertility counseling, and weight management.High School Diploma or GED equivalent, medical terminology course required or comparable experience required. Completion of MA course preferred. Requires previous experience reviewing medical chart, deciphering provider&#39;s chart notes and answering questions from medical review nurse in regards of previous medical treatment. Requires an understanding on how different medical insurances are processed. Requires previous experience providing excellent customer service to patients, physicians, nurses, and insurance companies. Previous fee-for-service insurance billing experience preferred. Must have previous experience working in a physician office, either as a medical assistant or biller. A minimum of one year experience in claims or referral processing. Must have proficient knowledge of medical terminology. Basic knowledge of insurance billing in a multi-specialty medical group required. Must have a good understanding of Fee-for-Service and HMO insurance guidelines. Understanding and ability to use CPT, HCPC and ICD-9 codes when conversing with medical review nurses; ability to practice established Sutter Gould Medical Foundation safety standards and maintain patient and employee confidentiality. Ability to review chart notes with medical review nurse and answer questions regarding previous medical treatment. Decision-making skills and the ability to organize and prioritize workflow; ability to work independently and meet deadlines;ability to be accurate and pay close attention to detail; ability to efficiently operate a PC and other office equipment; ability to maintain effective working relationships with co-workers and ability to maintain a clear and safe work environment. Requires critical thinking skills and clinical knowledge within the healthcare system. Maintain confidentiality regarding the release of medical information according to legal requirements and guidelines. This position must be able to work independently with little supervision. Ability to learn new computer systems used in the performance of the job. Requires someone who can be flexible in their work hours to meet the needs of the job. Ability to provide excellent customer service to Sutter Gould Medical Foundation customers, including physicians, nurses, patients, insurance companies, co-workers and Sutter Health affiliates; possess proficient communication skills, both verbally and written.

KEY REQUIREMENTS:

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