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Member Liaison Specialist (Customer Service) CalOptima Join Us in this Amazing Opportunity The Team You'll Join We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all. More About the Opportunity We are hoping you will join us as a Member Liaison Specialist (Customer Service) and help shape the future of healthcare where you'll be an integral part of our CS - Member Liaison team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. You will provide member service to seniors, persons with disabilities or chronic conditions, persons without housing and persons under the age of twenty-one (21) who participate in the Whole-Child Model program. You will serve as a liaison between members, health networks, providers and community-based organizations to facilitate access to services and help resolve health care and psychosocial issues. Together, we are building a stronger, more equitable health system. Your Contributions To the Team: 
<ul>
<li>85% - Member Support
<ul>
<li>Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.</li>
<li>Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.</li>
<li>Assesses members' concerns to identify psychosocial or health care issues and facilitate an appropriate resolution.</li>
<li>Intakes information from members, both over the phone and/or in person, to complete requests for assistance cases, grievances and appeals, per departmental guidelines.</li>
<li>Coordinates members' health care and social service needs within and outside the health network and CalOptima Health during the original interaction.</li>
<li>Addresses member and provider inquiries, questions and concerns in all areas, including enrollment, claims, benefit interpretation, coordination of care and referrals/authorizations for medical care related to services covered under the Whole-Child Model program.</li>
<li>Guides members in understanding and accessing the benefits under the Whole-Child Model program.</li>
<li>Maintains documentation of member cases within the FACETS system.</li>
<li>Initiates referrals to internal and external care management departments and government agencies.</li>
<li>Communicates with community-based organizations, health networks, providers and vendors on behalf of members to resolve disputes, helps coordinate access to care and investigates issues preventing members from receiving medical benefits and services. </li>
</ul>
</li>
<li>10% - Administrative Support
<ul>
<li>Collaborates with interdepartmental staff in call resolution as needed.</li>
<li>Identifies calls needing case management or escalation to a supervisor, manager or director and routes them according to established guidelines.</li>
<li>Meets all regulatory key performance indicators, first call resolution requirements and business objectives of CalOptima Health. </li>
</ul>
</li>
<li>5% - Other
<ul>
<li>Completes other projects and duties as assigned.</li>
</ul>
</li>
</ul>
 Do You Have What the Role Requires? 
<ul>
<li>High school diploma or equivalent PLUS 2 years of experience as a call center agent or customer/member services representative in health care required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.</li>
</ul>
 You'll Stand Out More If You Possess the Following: 
<ul>
<li>2 years of experience working with the needs of persons with disabilities and chronic medical conditions in a customer/member service capacity. </li>
<li>Health maintenance organization (HMO), Medi-Cal/Medicaid and health services experience. </li>
<li>Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Chinese, Farsi, Korean, Russian, Spanish, Vietnamese).</li>
</ul>
 What the Regulatory Agencies Need You to Possess? 
<ul>
<li>N/A</li>
</ul>
 Your Knowledge &amp; Abilities to Bring to this Role: 
<ul>
<li>Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. </li>
<li>Work independently and exercise sound judgment.</li>
<li>Communicate clearly and concisely, both orally and in writing.</li>
<li>Work a flexible schedule; available to participate in evening and weekend events.</li>
<li>Organize, be analytical, problem-solve and possess project management skills.</li>
<li>Work in a fast-paced environment and in an efficient manner.</li>
<li>Manage multiple projects and identify opportunities for internal and external collaboration.</li>
<li>Motivate and lead multi-program teams and external committees/coalitions.</li>
<li>Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.</li>
</ul>
 Your Physical Requirements (With or Without Accommodations): 
<ul>
<li>Ability to visually read information from computer screens, forms and other printed materials and information.</li>
<li>Ability to speak (enunciate) clearly in conversation and general communication.</li>
<li>Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.</li>
<li>Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.</li>
<li>Lifting and moving objects, patients and/or equipment 10 to 25 pounds</li>
</ul>
 Ways We Are Here For You 
<ul>
<li>You'll enjoy competitive compensation for this role.
<ul>
<li>Our current hiring range is: Pay Grade: 302 - $49,754 - $69,655 ($23.92 - $33.4880). 
<ul>
<li>The final salary offered will be based on education, job-related knowledge and experience, skills relevant to the role and internal equity among other factors. </li>
</ul>
</li>
</ul>
</li>
<li>This position is approved for Full Office (**If the position is Telework, it is eligible in California only**) </li>
<li>A <a href="https://apptrkr.com/get_redirect.php?id=6687129&amp;targetURL=https://www.caloptima.org/en/careers#benefits" target="_blank">comprehensive benefits package</a> </li>
<li>CalPERS pension program and additional retirement packages. </li>
<li>Additional benefits and perks including:
<ul>
<li>A generous PTO program</li>
<li>A quality work life balance</li>
<li>Various wellness programs</li>
<li>Tuition Reimbursement</li>
<li>Professional development opportunities</li>
<li>Career development opportunities</li>
<li>Flexible scheduling</li>
<li>And the satisfaction of knowing your work directly impacts and improves healthcare access for thousands of individuals and families.</li>
</ul>
</li>
</ul>
 Our Work Environment: If located at the 500, 505 Building or a remote work location: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.</li>
<li>There are no harmful environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate.</li>
</ul>
 If located at PACE: 
<ul>
<li>Work is typically indoors in a clinical setting serving the frail and elderly.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 If located in the Community: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. </li>
<li>Employee will occasionally work outdoors in varied temperatures.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 Why Join Us? We believe that diverse perspectives drive innovation. Each employee brings a unique perspective to the overall team and we value everyone's input and we are committed to creating an inclusive environment where you and every team member can thrive while making a meaningful impacts on our community members. Our team reflects and represents the communities we serve, and we welcome candidates from all backgrounds who share our commitment to accessible, quality healthcare. What's Your Next Step? All Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. Do NOT miss out. If you want to join our team, the deadline for the first review of applications is November 11, 2025 at 9:00 PM (PST). We are encouraging you to apply early. If you apply after the first review date, your application is not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. Our Commitment to You Your application and resume will be reviewed by a dedicated recruiter to this position. If your experience matches what we need, we will reach out to you to discuss the next steps. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. If you make it through the steps above and are selected for this exciting role, you will be required to undergo a reference and a background check (to include a conviction record) and if applicable also pass a drug screening and/or a post-offer pre-employment medical examination (for specific positions) If you are an Internal CalOptima Health applicant, please apply through the internal portal on InfoNet. We will make sure to keep you updated through each step of the process on your candidate portal. Please make sure to watch for updates on your candidate portal and you emails which will be sent to the email address you listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: <a href="https://apptrkr.com/6687129" target="_blank">https://jobs.caloptima.org/jobs/member-liaison-specialist-customer-service-505-city-parkway-west-california-united-states-c3fb6d6c-517c-418f-8d64-895099286932</a> Copyright 2025 Jobelephant.com Inc. All rights reserved. <a href="https://www.jobelephant.com/" target="_blank">Posted by the FREE value-added recruitment advertising agency</a> jeid-de8018e655f9b64388465261ce5f3fed

Member Liaison Specialist (Customer Service)

<h3>Job Description</h3>
Job DescriptionDescription:
Primary Job Function:
A Referral Specialist processes insurance pre-verification for hospital admissions or specialty service office visits. Gathers pertinent information from patients, insurance carriers, financial counselors, and other staff to confirm the patient's financial obligations for services. acts as a liaison between hospitals, clinical staff, health plans, providers, and patients to process referrals. Verifies insurance coverage and obtains required authorizations. Additionally, Referral Specialist resolves pre-certification, registration, and case-related issues. Documents referrals, communications, actions, and other data in an information system. Generates and distributes all applicable forms, notifications, and paperwork.
 
Essential Job Functions:
<ul>
<li>Works in our EHR to receive referrals from providers.</li>
<li>Process referrals according to the orders.</li>
<li>Obtains prior authorization for payment from the patient's insurance4 company.</li>
<li>Secures appointment with other providers, lab, radiology, etc..</li>
<li>Communicates with the patient to verify appointment time and any information they may need to take to the appointment.</li>
<li>Communicate effectively with all providers and office staff to ensure that everyone is aware of necessary information related to patient care.</li>
</ul>
Requirements:
Knowledge, Skills and Abilities:
<ul>
<li>Demonstrates clinical competency as identified by certifications and training.</li>
<li>Assumes responsibility for own continued personal and professional development.</li>
<li>Appropriate manner, conduct y and grooming.</li>
<li>Ability to work cooperatively and communicate effectively.</li>
<li>Good health and consistent attendance</li>
<li>Working knowledge of basic computer skills.</li>
</ul>
Education and Experience:
<ul>
<li>Current LPN license preferred</li>
<li>Clinic experience preferred</li>
</ul>
Essential Job Duties:
<ul>
<li>Receive referrals through the HER from providers at THMH.</li>
<li>Verify insurances by using various websites, phone and fax.</li>
<li>Establish appointments with appropriate facility, office, physician.</li>
<li>Notify patient of appointment time and any additional information that is needed for procedure/appointment.</li>
</ul>

Referral Specialist

<h3>Job Description</h3>
Job DescriptionSalary: $22/Hour - $30/Hour DOE 
Founded in 1982 as Joliet Area Community Hospice, Lightways Hospice and Serious Illness Care is an independent, nonprofit healthcare provider licensed in 11 counties in northwest Illinois. We provide exceptional serious illness care, hospice care and grief support for adults and children.
 
The majority of our direct patient care is in the field with Lightways team members providing care in the home, nursing facility or assisted living facility. We also have a 20-bed inpatient unit in Joliet. Non-clinical staff are based out of our Joliet administrative offices.
 
This full time position works Mon - Fri from 10 am - 6:30 pm and every fourth weekend Saturday &amp; Sunday from 8 am - 4:30pm. This position is hybrid and consists of 3 days in the office, 2 days remote per week. This position creates hospice charts, intake new referrals, schedule appointments, establish and maintain positive relationships with customers and referral sources. The qualified candidate will have a minimum of one (1) year experience in hospice or healthcare and excellent communication skills. Candidate must have excellent organizational and communication skills with the proven ability to multi-task.
 
This is a full time position eligible for full benefits after 30 days. Lightways offers medical, dental, vision, a generous paid time off (PTO) plan and 401k with a matching benefit.
 
Lightways has a generous benefit plan which includes medical, dental, vision, short and long term disability, life insurance, generous paid time off (PTO) and a 401K plan with a company match.
 
For additional information on Lightways benefit package, please visit Lightways.org and click on Careers.

<h3>Job Description</h3>
Job Description
INTRODUCTION 
Company Overview:
BioMatrix is a nationwide, independently-owned infusion pharmacy with decades of experience supporting patients on specialty medication. Our compassionate care team helps patients navigate the often-challenging healthcare environment. We treat our patients like family and get them started on therapy quickly. We work closely with them as well as their family and their healthcare providers throughout the patient journey, staying focused on optimal clinical outcomes.
 
At BioMatrix the heart of our Inclusion, Diversity, Equity, &amp; Access (IDEA) philosophy is the commitment to cultivate a welcoming space where everyone’s contributions are acknowledged and celebrated. Our goal is to draw in, develop, engage, and retain talented, high-performing individuals from diverse backgrounds and viewpoints. We believe that both respecting and embracing diversity enriches the experiences and successes of our patients, employees, and partners.
Schedule &amp; Location:
Varied 8-Hour Schedules : Pacific Time Zones- Monday-Friday 10 am-6:30 pm, with some weekends based on need.
 
It is anticipated that an incumbent in this role will work onsite in Las Vegas, NV. 
​ 
 Job Description:
​ 
As a key member of the referral services team, a Referral Specialist will serve as the primary contact to a referral source (prescriber, provider, healthcare center, system, and/or practice), the patient for whom the referral is for, and the field-based sales representative associated with the referral source account. In this role, the Referral Specialist will be responsible for navigating a new prescription via a referral from a referral source through the necessary steps to determine whether it can be serviced in the BioMatrix network of pharmacies.
A Referral Specialist will be aligned to a geographic territory of referral sources and corresponding field-based sales team member(s). This role will work closely with data entry, reimbursement, nurse coordination, and pharmacy operations team members supporting various stages of the referral and pharmacy management processes and will understand the referral status and next steps for each referral they are responsible for supporting. The Referral Specialist will build and maintain strong and lasting relationships with key personnel within the referral source environment using effective and timely communication ensuring their patient referrals are managed through service determination in a seamless manner.
QUALIFICATION REQUIREMENTS
<ul>
<li>High school diploma or GED required</li>
<li>Minimum of one (1) year of experience managing patient referral and prescription activities or reimbursement services in infusion or specialty therapies required</li>
<li>Minimum of one (1) year of experience providing customer service in health care setting (patients and/or providers), including meeting high quality standards for services and evaluation of customer satisfaction required</li>
<li>Electronic health medical record or pharmacy patient management experience</li>
<li>Ability to multitask in a fast-paced environment</li>
<li>Proficient in medical or pharmacy terminology, written or verbal</li>
<li>Moderate skills in Microsoft Office (including Word, Excel, PowerPoint, etc.)</li>
<li>Willing to travel up to 5% of the time for business purposes (when necessary to attend meetings, conferences, seminars, etc.)</li>
</ul>
QUALIFICATIONS PREFERRED
<ul>
<li>Bachelor’s degree preferred</li>
<li>Minimum of one (1) year of experience in supporting prescriber, healthcare setting, patient, and field facing communications related to referral or prescription services in infusion or specialty therapies preferred</li>
<li>General understanding of prescription benefits, insurance/payer requirements, and verification processes</li>
<li>General experience working in a health care setting or services environment</li>
<li>General knowledge of infusion therapy process and patient needs</li>
</ul>
ESSENTIAL FUNCTIONS AND RESPONSIBILITIES
<ul>
<li>Build relationships with assigned referral sources and associated BioMatrix field representatives through communication and coordination with key personnel responsible for pharmacy referral activities within the healthcare setting</li>
<li>Serve as point of contact to referral source and keep necessary referral source personnel well informed of the status of referrals sent to BioMatrix for service</li>
<li>Follow-up with referral source, patient, and/or caregiver to collect all required information and data sets needed to support the referral process activities (including but not limited to patient demographic, pharmacy/medical benefits, clinical history, and/or prescription details)</li>
<li>Work closely with Reimbursement Specialists and conveys outcomes of benefit investigation activities with patient when it comes to patient out of pocket costs, financial responsibility, and financial assistance options for patient support consideration</li>
<li>Work closely and communicate with Nurse Coordination team for those patients who intend to move forward with service and require in-home nurse care to be scheduled and organized around prescription fulfillment and shipping</li>
<li>Work closely and communicate with Pharmacy operations team members ensuring clinical and fulfillment resources have everything they need to successfully support the on-boarding and on-going fulfillment for a new patient referral/prescription</li>
<li>Produce written documentation representing all provider, patient, caregiver, and/or field team updates and communications in necessary systems of record</li>
<li>Understand referral turn-around time, volume, and workload metrics and goals established by leadership; use goals to effectively organize referral workload and daily activities for successful outreach and completion of referral steps needed to attain service outcomes/determination</li>
<li>Support use of technology and other innovative digital channels for internal and external stakeholder communication as directed by leadership; leverage professional and effective communication skills when utilizing technology for written correspondence with these stakeholders</li>
<li>Have strong understanding of referral and prescription management processes and available services to effectively convey status, outcomes, and next steps to team members as well as referral source, patients, and field resources as expected and needed</li>
</ul>
NON-ESSENTIAL FUNCTIONS &amp; RESPONSIBILITIES
<ul>
<li>Ability to prioritize and handle multiple tasks and projects concurrently</li>
<li>General knowledge and understanding of referral profitability and reimbursement options related to referral and patient population being served</li>
<li>Support general administrative activities to navigate patient, provider, and field outreach (i.e. mailings, documentation development, scheduling of meetings/discussions, etc.)</li>
<li>Must have scheduling flexibility and be able to work overtime (from time to time upon request)</li>
<li>Careful attention to detail</li>
<li>Act as a resource to other departments and participate in department meeting and office presentations with your expertise in this area of referral services</li>
<li>Performs related duties as requested by leadership</li>
<li>Participates in quality assurance activities and audits as directed</li>
<li>Overnight travel on occasion by car and airplane</li>
</ul>
KNOWLEDEGE, SKILLS AND ABILITIES REQUIREMENTS
<ul>
<li>Excellent customer service and communication skills (both written and verbal)</li>
<li>Working knowledge of medical terminology</li>
<li>Ability to perform referral related work and tasks in an organized fashion with focus on complete information and time related deadlines</li>
<li>Ability to complete multiple projects with time sensitive deadlines</li>
<li>Ability to manage more than one priority project at a time</li>
<li>Ability to work as part of a team/committee to complete assigned tasks</li>
<li>Ability to exercise independent judgment and at times, work independently</li>
<li>Ability to enlist cooperation of other people and department in completing assigned work and projects</li>
</ul>
<ul>
<li>Ability to actively communicate, inspire and motivate peers, customers, and other stakeholders encountered in the referral services department</li>
<li>Ability to think and act strategically and proactively</li>
<li>Ability to maintain accurate records and prepare reports and correspondence related to the work</li>
</ul>
Communication Skills 
<ul>
<li>Oral Communication - Speaks clearly and persuasively in positive or negative situations; listens and gets clarification; Responds well to questions; demonstrates group presentation skills; actively participates in meetings</li>
<li>Written Communication - Writes clearly and informatively with professional context and direction; edits work for spelling and grammar; varies writing style to meet needs of audience; presents qualitative and quantitative data effectively; able to read and interpret written information effectively.</li>
</ul>
Computer Skills 
<ul>
<li>Become and remain proficient is all technology platforms, applications, and programs necessary to perform referral specialist duties</li>
</ul>
PHYSICAL DEMANDS AND WORK ENVIRONMENT
<ul>
<li>This position requires constant sitting with occasional walking, standing, kneeling or stooping.</li>
</ul>
<ul>
<li>This position requires the use of hands to finger, handle or feel objects and the ability to reach with hands and arms.</li>
<li>This position requires constant talking and hearing.</li>
<li>Specific vision abilities required by this job include close vision and the ability to adjust focus.</li>
</ul>
<ul>
<li>This position must occasionally lift and/or move up to 20 pounds</li>
<li>Required to move/lift physical hardware.</li>
</ul>
PHYSICAL DEMANDS 
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. If needing a reasonable accommodation within the application process, please contact the BioMatrix People &amp; Culture team at <a href="mailto:Careers@BioMatrixsprx.com" target="_blank">Careers@BioMatrixsprx.com</a> or 954.385.7322 x 1425.
 
While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch or crawl; talk or hear; taste or smell. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus. 
OTHER 
<ul>
<li>Will participate in legal and ethical compliance training each year.</li>
<li>Will consistently behave in compliance with the BioMatrix, LLC’s legal and ethical policies and procedures.</li>
<li>Will abide by the policies of BioMatrix, LLC as set forth in the Compliance Manual.</li>
<li>Will not participate in any conduct considered to be unethical or illegal.</li>
</ul>

EXPECTATION FOR ALL EMPLOYEES 
Supports the organization's mission, vision, and values by exhibiting the following behaviors: integrity, dedication, compassion, enrichment and enthusiasm, places patients first, is all-in with stacked-hands, and is focused on relentless consistency wins.
GENERAL INFORMATION: 
The above statements are intended to describe the general nature and level of work being performed by individuals assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required of personnel so classified.
The incumbent must be able to work in a fast-paced environment with demonstrated ability to juggle and prioritize multiple, competing tasks and demands and to seek supervisory assistance as appropriate.
Incumbents within this position may be required to assist or find appropriate assistance to make accommodations for disabled individuals in order to ensure access to the organization's services (may include: visitors, patients, employees, or others).
 
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

<h3>Job Description</h3>
Job DescriptionSalary: Starting at $15.00 p/hr 
The Referral Specialist is responsible for seeing that timely specialist/procedural referrals are made which follow that patients insurance and referring providers specifications. 
 
Qualifications:
<ul>
<li>Understands and has the ability to demonstrate the importance of exemplary customer service. </li>
<li>Ability to exercise critical thinking skills, multi-task, take initiative, and take ownership to follow through with responsibilities according to established policies and procedures. </li>
<li>Ability to work cooperatively as a productive member of a team. </li>
<li>Ability to use multi-line phone system, computer systems, and general office equipment. </li>
<li>Ability to type proficiently and understand the keyboard. Trustworthiness and accuracy in money-handling. </li>
<li>Ability to adapt to change and new technologies to perform successfully. </li>
<li>Ability to comply with HIPAA laws and accreditation requirements. </li>
<li>Ability to correspond and access databases preferred.</li>
</ul>
 
Location:Cadillac, MI
Exempt/Non-Exempt: Non-Exempt
Benefits: Full benefits package 
Employment Type: Full Time
 
Family Health Care is an Equal Opportunity Employer.

<h3>Job Description</h3>
Job DescriptionSalary: $22/Hour - $30/Hour DOE 
Founded in 1982 as Joliet Area Community Hospice, Lightways Hospice and Serious Illness Care is an independent, nonprofit healthcare provider licensed in 11 counties in northwest Illinois. We provide exceptional serious illness care, hospice care and grief support for adults and children.
 
The majority of our direct patient care is in the field with Lightways team members providing care in the home, nursing facility or assisted living facility. We also have a 20-bed inpatient unit in Joliet. Non-clinical staff are based out of our Joliet administrative offices.
 
This full time position works Mon - Fri from 10 am - 6:30 pm and every fourth weekend Saturday &amp; Sunday from 8 am - 4:30pm. This position creates hospice charts, intake new referrals, schedule appointments, establish and maintain positive relationships with customers and referral sources. The qualified candidate will have a minimum of one (1) year experience in hospice or healthcare and excellent communication skills. Candidate must have excellent organizational and communication skills with the proven ability to multi-task.
 
This is a full time position eligible for full benefits after 30 days. Lightways offers medical, dental, vision, a generous paid time off (PTO) plan and 401k with a matching benefit.
 
Lightways has a generous benefit plan which includes medical, dental, vision, short and long term disability, life insurance, generous paid time off (PTO) and a 401K plan with a company match.
 
For additional information on Lightways benefit package, please visit Lightways.org and click on Careers.

<h3>Job Description</h3>
Job Description
Rome Health is seeking a Referral Specialist who will schedule appointments for patients for testing and/or to see specialists as ordered by the patient's provider of care. The Referral Specialist will:
 •Adhere to Rome Health's Compliance Plan, Policies and Procedures, HIPAA Privacy and Security, Safety and PCMH Health Policies to maintain a quality level of service for patients and protect the confidentiality of patients Protected Health Information (PHI).
•Answer phone calls and assist patients with questions as needed.
•Maintain ongoing tracking and appropriate documentation of referrals.
•Assemble information concerning patient's clinical background and referral needs. Per referral guidelines, provide appropriate clinical information to specialist.
•Contacts insurance carriers to obtain and ensure prior approval requirements and/or authorizations are met. Present necessary medical information such as history, diagnosis and prognosis.
•Records time and date of appointment and method of patient notification in EMR.
•In coordination with guidelines for PCMH, review details and expectations about the referral with the patient, explaining any special instructions regarding test ordered and provides written instructions as applicable.
•Ensures that referrals are addressed in a timely manner.
•Contact patients with scheduled appointments via mail or phone.
•Maintains good communication skills with providers, supervisors, coworkers, patients and other departments, as applicable.
•Performs other related duties as necessary to maintain efficient workflow.
•Answering phones and other receptionist duties included.
SKILLS AND QUALIFICATIONS:
•High School diploma •Knowledge of referral process and insurance industry. •Organized, meticulous, with great attention to detail and able to manage priorities. •Effective verbal and written communication skills.
 
About Rome Health
Rome Health is a non-profit health care system based in Rome, N.Y., providing services to patients throughout Central New York. From primary and specialty care to long-term care, Rome Health delivers quality, compassionate medical care for every stage of life. We are a comprehensive health care system that connects you to the best clinicians and the latest technologies so they are easily accessible to you and your family. Rome Health is an affiliate of St. Joseph's Health and an affiliated clinical site of New York Medical College. The best care out there. Here.

<h3>Job Description</h3>
Job Description
Join a Team That Makes a Difference at Optimus Health Care!
Are you passionate about providing high-quality, patient-centered care? Optimus Health Care the largest provider of primary health care services in Fairfield County is looking for dedicated professionals to join our team! With multiple locations in Bridgeport, Stratford, and Stamford, our mission is to be a lifelong health care partner, dedicated to achieving optimal wellness for the communities we serve.
Join our team-based model of care delivered in a kind and compassionate manner.
We are currently recruiting for a Full Time Referral Specialist forour location in Bridgeport, CT
 The Referral Specialist ensure that referrals are entered in the system for follow up and tracking in accordance with the Referral Process.
ESSENTIAL FUNCTIONS &amp; RESPONSIBILITIES
<ol>
<li>Oversee the referral coordination to specialty services.</li>
<li>Coordinate appointments for specialty services as requested by primary care physician</li>
<li>Collect proper supporting data for each referral before sending to specialist</li>
<li>Provide reports as needed to the Practice Manager(s)</li>
<li>Be the point of contact for hospitals and specialty offices</li>
<li>Respond to inquiries as to current status of referral by assessing the request and evaluating the circumstances to provide the correct information </li>
<li>Verify prior authorizations with insurance companies via phone, in writing or electronically </li>
<li>Inform patient of appointment date, time and required documentation needed prior to appointment </li>
<li>Provide patient teaching prior to appointment</li>
<li>Review logs on weekly basis to ensure patient kept his/her appointment</li>
<li>Open and review flags regarding consults</li>
<li>Document entry in EMR as a non-billable encounter and enter the specialty appointment in the Referral log</li>
<li>Log any No shows and flag the referring physician for follow up with patient</li>
<li>Direct patient to outside resources when needed as requested by primary care physician</li>
</ol>
Professional positive attitude, vision, understanding of customer service principals, trustworthiness, and excellent interpersonal skills to successfully accomplish tasks necessary to meet high standards of ethical and social responsibility required by this position. 
JOB QUALIFICATIONS/REQUIREMENTS
EDUCATION: High School Diploma/GED required. Graduated from an accredited Medical Assistant Program, preferred. Intimate knowledge of language and culture of a sizeable segment of community served by the Health Center. 
EXPERIENCE: 2+ years’ experience in a clinical setting preferred.
LANGUAGE SKILLS: Bilingual preferred – Spanish, Portuguese and/or Haitian-French Creole
 SKILLS: Microsoft Excel and Word. Must have organizational skills, excellent communication skills, and ability to work under pressure.
 REASONING ABILITY: Critical thinking, analytical and problem solving skills
 LICENSURE / CERTIFICATION: None
To be part of our organization, every employee should understand and share in Optimus’ Vision, support our Mission, and live our Values. These values-outstanding, patient-centered, trustworthy, integrity, multicultural, understanding, and supportive -help guide what we do, as individuals and professionals, every day.
<ul>
<li>OHC provides a fun, fast-paced working environment, where our commitment to quality is present in every job function.</li>
<li>Excellent health &amp; welfare benefit </li>
<li>Competitive Compensation</li>
<li>Optimus and its caring and multi-lingual staff proudly serve hundreds of thousands of our neighbors, in a caring patient-centered environment.</li>
</ul>
 Optimus is committed to providing equal employment opportunities to all applicants and employees as protected by applicable federal and/or state law.

<h3>Job Description</h3>
Job DescriptionSalary: $21-$26 
WE ARE TITANIUM HEALTHCARE
Titanium is a healthcare company that puts heart and compassion above all else. Millions of Americans just arent getting the medical care they need. Were on a mission to change that. For patients that means exceptional support and better care. For providers it means better support and time to focus on patients, and for partners that means higher quality and lower cost.
Join us in our mission!
POSITION SUMMARY
The Referral Specialist plays a crucial role in facilitating the seamless transfer of patients between healthcare providers and ensuring that patients receive appropriate care in a timely manner. This position involves coordinating referrals, obtaining necessary authorizations, and communicating with patients, healthcare providers, and insurance companies to ensure smooth transitions of care.
WHERE YOULL WORK
This position is hybrid. Work from home and go into the field as needed throughout Fresno County. Standard business hours are Monday through Friday from 8:30 am to 5:00 pm.
WHAT YOULL DO
<ul>
<li>Evaluate referral requests for ECM eligibility</li>
<li>Gather member information and medical records to support referrals</li>
<li>Coordinate referrals with Titanium staff, hospitals, shelters, and other healthcare entities</li>
<li>Verify insurance coverage and upload required documents into eClinicalWorks</li>
<li>Communicate with members to schedule appointments and address concerns</li>
<li>Maintain accurate records of referral activities and provider communications</li>
<li>Work with Titanium clinical staff to process internal ECM referrals</li>
<li>Monitor referral progress and follow up to ensure timely completion</li>
<li>Resolve referral-related issues, such as insurance denials or missing documentation</li>
<li>Stay updated on ECM criteria, referral policies, and healthcare service changes</li>
<li>Conduct telephonic and in-person outreach, assessments, and referrals as needed</li>
<li>Perform other duties and projects as assigned</li>
</ul>
 
WHO YOU ARE
<ul>
<li>Fluent in English (written and verbal)</li>
<li>Strong communication skills, both written and verbal, with the ability to effectively interact with patients, healthcare providers, and insurance companies</li>
<li>Excellent organizational skills and attention to detail to ensure accurate documentation and timely completion of referrals</li>
<li>Proficiency in computer applications, including electronic health record systems, scheduling software, and Microsoft Office</li>
<li>Ability to work independently and prioritize tasks in a fast-paced environment</li>
<li>Commitment to maintaining patient confidentiality and adhering to ethical standards in healthcare practice</li>
</ul>
WHAT YOULL NEED
<ul>
<li>High School Diploma</li>
<li>Minimum 1 year of experience in customer service, preferably in healthcare or social services</li>
<li>Current and valid Drivers License with proof of auto insurance</li>
<li>Distraction-free home workspace with a secure internet connection</li>
</ul>
 
NICE TO HAVES
<ul>
<li>Prior experience in an outbound call center, community outreach, and canvassing</li>
<li>Prior experience in healthcare or social services</li>
<li>Prior experience using an EHR/EMR system</li>
<li>Bilingual in Spanish</li>
</ul>
WHAT YOULL ENJOY
<ul>
<li>Make an impact: an organization who cares about its employees, communities, and the future of healthcare</li>
<li>Inclusivity: be a part of a workplace where you not only belong but also can be the best version of yourself</li>
<li>Growth: opportunities to develop and grow your career with us</li>
<li>Community: you are encouraged to have a voice, share your opinions, and have an individual impact on the business</li>
<li>Paid Time Off: 12 holidays and up to 15 days of accrued PTO to rest and recharge plus additional time for sick, jury duty, bereavement, reproductive loss, and therapy</li>
<li>Work Life Balance: enjoy flexibility to maximize your well-being and success with our hybrid work model</li>
<li>Medical, Dental, &amp; Vision Benefits: we cover up to 100% of your premium and 50% of your dependents depending on the plan</li>
<li>Prioritize your mental health with unlimited therapy sessions funded 100% by Titanium Healthcare</li>
<li>Flexible Spending, Health Savings &amp; Dependent Care Accounts</li>
<li>Life/AD&amp;D insurance funded 100% by Titanium Healthcare</li>
<li>Supplemental Short-Term Disability</li>
</ul>
<ul>
<li>Employee Assistance Programs</li>
<li>Protect your pet(s) with Pet Insurance</li>
<li>401(k) plan</li>
</ul>
EEO Statement
At Titanium Healthcare, our mission is to fearlessly reengineer the way healthcare works to reduce costs, ensure better outcomes, and provide everyone, everywhere, with the kind of compassionate and coordinated care they deserve. We believe that achieving this mission starts with a diverse and inclusive workforce.
Titanium Healthcare is an equal opportunity employer. We are committed to promoting and celebrating all backgrounds and encourage all applicants, regardless of race, religion, gender, sexual orientation, disability, age, marital status, parental status, military or veteran status, or any other legally protected status, to apply. We believe that diversity and inclusion drive innovation and equity in healthcare, enabling us to better serve our communities and make a lasting impact.

<h3>Job Description</h3>
Job Description

Since 1969, MACT Health Board’s mission has been to improve the health status of the American Indian and Alaskan Native population. Our goal is to continue to provide high quality care to our patients throughout a variety of services, including Medical, Behavioral Health, Chiropractic, Dental, Optometry, Massage Therapy, Women’s Health, and more. 
Why MACT Health Care Inc?
Are you searching for a career that offers more than just a paycheck? A career where your professional skills directly empower the health and well-being of our local communities? At MACT Health Board, that’s not just an idea—it’s our daily mission and we invite you to explore our Career Opportunities. You won’t be just another employee; you’ll be a valued member of a team committed to making a difference and we know that taking care of our community starts with taking care of our own. We reward our employees with competitive compensation, benefit options and provide training and advancement opportunities to provide you with the skills to succeed in your future! Our careers offer a unique balance of philanthropic opportunities, cultural preservation and individual value! When you join MACT, you’ll enjoy:
<ul>
<li>Medical, Dental, Vision, and life insurance benefits at no-cost to the employee</li>
<li>403(b) retirement plan, PTO including vacation, sick time, paid holidays and more</li>
<li>Balanced working hours; Monday-Friday 8-5pm. </li>
<li>Student Loan Repayment Program</li>
<li>Direct Student Loan Contributions: Our BenefitED program allows us to make direct quarterly contributions to your student loans to help you pay them off faster</li>
<li>Continuing Education credits: We empower our providers to stay at the top of their field. We offer reimbursement for continuing education and licensure fees.</li>
<li>Competitive Salary of $24.56-$27.72 hourly</li>
</ul>
Who you are:
We are seeking a detail oriented Referral Specialist for a Full role working in a clinical setting. As a member of the health care team, the Referral Specialist is responsible for the referrals, diagnostic orders and surgery coordinating of patients to outside agencies, and the appropriate follow-up of those referrals. The Referral Specialist will:
<ul>
<li>Expedite the delivery of referrals, diagnostics orders and surgery coordination of patients including:
<ul>
<li>Insurance verification and prior authorizations</li>
<li>Transmission of all required medical records to outside facilities</li>
<li>Facilitate appointment scheduling or rescheduling for specialty care</li>
</ul>
</li>
<li>Completion of follow-up on all including:
<ul>
<li>Confirming receipt of referrals</li>
<li>Referral tracking and documentation of activities to include all elements of a referral.</li>
<li>Receipt of medical records and attaching them to the medical chart.</li>
</ul>
</li>
<li>Respond to: telephone calls, faxes and e-mails regarding referrals and provide information with respect and courtesy while being effective and efficient.</li>
<li>Demonstrate ongoing knowledge and documentation of appropriate referral resources, required forms and key contact persons.</li>
<li>Connect and communicate with medical staff such as providers, medical assistants, and other MACT staff at outside facilities, to ensure efficient workflows</li>
</ul>
What you need:
<ul>
<li>High school diploma or equivalent.</li>
<li>Medical Terminology.</li>
<li>Medical Office experience.</li>
<li>One year of experience as a referral clerk or similar type duties working with referral of patients for treatment.</li>
<li>One year of experience as a medical receptionist, medical assistant, or procedure scheduler or satisfactory completion of a medical receptionist/medical assistant training program.</li>
<li> Knowledge of medical computer programs: Next Gen EPM, EHR, i2i Tracks, Epic and other HIE’s. </li>
<li>Knowledge and training in the HIPAA regulations related to patient care documentation, eligibility process and compliance to the regulations.</li>
<li>Good detail analysis, accuracy, oral and written communication, patience and tact required. </li>
</ul>
<ul>
<li>Current BLS/ALS certificate</li>
<li>Must pass Occupational Health Screening.</li>
<li>Must possess a valid form of identification as listed on the U.S. Department of Justice I-9 form, verified using the E Verify system.</li>
<li>Clean DMV driving record and MACT auto insurance driving eligibility (determined by auto insurance carrier).</li>
</ul>
The position requires an awareness and keen appreciation of American Indian traditions, customs, and socioeconomic needs and the ability at all times to meet and deal effectively in contacts with Indian health organizations which requires tact, courtesy, discretion, resourcefulness and good judgment in handling functions of a sensitive nature.
AMERICAN INDIAN PREFERENCE: 
Preference in filling of a vacancy will be given to qualified American Indian applicants in accordance with the Preference Act (Title 25, U.S. Code, Sections 472 &amp; 473) and Public Law 93-638, provided the applicant has submitted appropriate verification of Indian preference for employment. Other than the aforementioned requirement, the MACT Health Board, Inc. is an Equal Opportunity Employer.
NOTICE OF DRUG-FREE WORKPLACE ACT REQUIREMENT:
MACT Health Board, Inc. is required to implement the Drug-Free Workplace Act of 1988, 45 CFR Part 79, Subpart F. As such it is unlawful for employees to manufacture, distribute, dispense, possess, or use a controlled substance on the job site. Employees who are reasonably suspected of violating this act may be subject to drug testing as a condition of employment. Employer required fitness examinations shall include drug testing as evidence of employee and employer compliance with the Drug-Free Workplace Act.

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