Referral Services Tech / Medical Assistant

HOURS: Monday - Friday, 8:00 AM - 5:00 PM - no evenings or weekends!

PUYALLUP TRIBAL HEALTH AUTHORITY, located in Tacoma, Washington is seeking a full-time Referral Services Technician (Medical Assistant).

“It is the mission of the Puyallup Tribal Health Authority to provide quality healthcare and promote wellness in a culturally appropriate manner.”

We offer an outstanding workplace, competitive market based salary, and benefits packages including:

• Monday – Friday schedule
• Medical/Dental/Vision benefits – monthly premiums paid 100% for employees
• 18+ annual paid holidays
• Generous paid sick and vacation accruals
• 401(k) with annual profit sharing
• Life & AD&D insurance coverage
• PTHA is an approved loan repayment site for various programs
• Employee Assistance Program
• Excellent work/home life balance

GENERAL FUNCTION: Provides complete referral processing services for patients and providers in a timely, accurate and professional manner, for all referral types, including insurance authorizations.

ESSENTIAL JOB FUNCTIONS:

• Accurately process and/or task (order) patient referrals when received, origination through completion, for those who meet eligibility requirements, using online resources to assign appropriate codes when missing. Process Priority 1 referrals and those scheduled the same day, upon receipt and/or within 24 hours and Priority 2 within 48 hours, without error.
• Provide excellent customer service at all times including, assisting PTHA staff & patients, answer incoming calls, document phone conversations and other requests from patients and providers in EHR system, and return messages within one business day.
• Verify and explain patient eligibility and financial responsibility for Medical/Dental benefits. This includes completing insurance pre-authorizations to confirm exclusions and limitations of services, and assignment of correct funding of Referred Services, Dental, or Contract Care Funds as the primary or secondary coverage, if applicable, prior to services being scheduled.
• Promptly inform supervisor when referral problems arise that impact the processing of referrals in a timely and efficient manner (as defined above).
• Knowledgeable of medical and/or dental terminology, coding, diagnosis and various treatment procedures. Obtain patient treatment plans and/or x-rays and ensure information and referrals are accurately entered EHR/EDR system in a timely manner or by given deadline.
• Work with out of area Puyallup Tribal Members to find available medical/dental services in their area and work with provider offices on obtaining necessary information for acceptance of services.
• Collect required NPI & Tax ID numbers and required billing information for “new“ providers/vendors and submit required paperwork to appropriate department for processing, within 1 business day of request.
• Collaboratively work with all PTHA departments and outside providers on referral processing, communicate and troubleshoot approvals/denials in a timely manner and coordinate approved patient care and treatment.
• Work closely with Patient Accounts, to process all “pending” referrals weekly, using Next Gen reports, by identifying and updating referrals that are eligible for alternate coverage or completion by CDR. Resolve all billing issues to ensure proper adjudication of referrals for accurate claims payment.
• Identify uninsured patients with ongoing, serious, chronic conditions and connect them with resources to apply for alternate coverage (i.e. Medicaid, Disability).
• Notify Member Services when requests are received for Puyallup Tribal Members without an established referral and upon authorization, process referral immediately and notify provider/patient to ensure care is not impacted.
• Provide training for new staff and assist with system upgrade testing and implementation of process changes as new workflows are developed.

• High School Diploma or GED.
• Current WA State Medical Assistant certification.
• Demonstrable proficiency and knowledge of medical and/or dental terminology, coding and MS Office products (Word, Excel, Outlook, etc.), with accurate and efficient keyboarding and data-entry skills.
• Within the last four years must have two years MA experience in a family medicine/clinic setting working directly with insurance, referrals and with providers/patients, and experience pre-authorizing clinical services with private and State insurances.
• Excellent customer service and communication skills and experience working with Electronic Health Records system.