Coord Outside Referral UHW
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Before you apply
SalaryNo pay range posted
LocationDowney, CA, US
Work modeon-site
Typefull-time
SeniorityEntry
Company size10,000+ people
PostedNov 3, 2026 · 3d ago
Verified live3d ago
At a glanceSummarised by Seekless from the posting.
Reviews physicians requests for outside medical services
Verifies patient eligibility and contacts both outside facility and patient regarding billing procedures and appointment scheduling
Reviews and processes billings received from outside medical providers
Verifies authorized services prescribed, determines accuracy and appropriateness of charges
Determines whether questionable billings received are to be considered for payment through the outside medical referral system and reroutes billings
Follows up on outstanding accounts
Sets up and maintains files on all outside referral patients
Sets up files on all no-bed patients and pre-scheduled surgeries, notifies patients and outside providers and processes invoices
Educates community hospital personnel, physicians and billing services regarding Kaiser Outside Medical referral and reimbursement policies and practices, covered benefits and authorized services
Interpret SCPMG, KFH and KFHP policies and answer inquiries from Kaiser members, physicians and other involved personnel and support staff
Act as liaison between Regional Offices and local Outside Referral desk to coordinate and implement all Outside Medical Systems for SCPMG associated with use of non-Kaiser facilities for the purposes of: in and out patient referrals, supplemental bed and pre-scheduled surgeries
Provide accurate information to outside providers and members to help facilitate most appropriate route of health care
Interpret and implement necessary procedures regarding contractual agreements between Kaiser Permanente and Community Hospitals and physicians
Performs other administrative duties as required
Job Summary:
Under direct supervision, maintains current records of all physician outside referrals of Kaiser Permanente Health Plan members, verifies that outside referrals have proper authorizations for prescribed services, monitors expenditures to determine appropriateness of payment per established guidelines, and sets up reporting systems for the processing of forms required for outside referrals and the payment of outside services rendered.
Essential Responsibilities:
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Reviews physicians requests for outside medical services.
•
Verifies patient eligibility and contacts both outside facility and patient regarding billing procedures and appointment scheduling.
•
Reviews and processes billings received from outside medical providers.
•
Verifies authorized services prescribed, determines accuracy and appropriateness of charges.
•
Determines whether questionable billings received are to be considered for payment through the outside medical referral system and reroutes billings.
•
Follows up on outstanding accounts.
•
Sets up and maintains files on all outside referral patients.
•
Sets up files on all no-bed patients and pre-scheduled surgeries, notifies patients and outside providers and processes invoices.
•
Educates community hospital personnel, physicians and billing services regarding Kaiser Outside Medical referral and reimbursement policies and practices, covered benefits and authorized services.
•
Interpret SCPMG, KFH and KFHP policies and answer inquiries from Kaiser members, physicians and other involved personnel and support staff.
•
Act as liaison between Regional Offices and local Outside Referral desk to coordinate and implement all Outside Medical Systems for SCPMG associated with use of non-Kaiser facilities for the purposes of: in and out patient referrals, supplemental bed and pre-scheduled surgeries.
•
Provide accurate information to outside providers and members to help facilitate most appropriate route of health care.
•
Interpret and implement necessary procedures regarding contractual agreements between Kaiser Permanente and Community Hospitals and physicians.
•
Performs other administrative duties as required.
•
CLAUSE - APPLICABLE TO KERN COUNTY (BAKERSFIELD) POSITIONS ONLY In Kern County Only, this position may only be filled by a candidate to be stationed at 5055 California Avenue. Please use represented Job Code 18800 when posting this position for any other Bakersfield location.
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Should you have questions please contact your local HR, Labor Representative, or Regional Compensation Consultant.