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Kaiser Permanente Careers

Customer Service

Making Each Interaction Extraordinary

Functioning as a liaison between our members, employer groups, providers, brokers, and internal customers, our customer service groups are the face and voice of Kaiser Permanente. They play a vital role in explaining our offerings, policies, and procedures as well as meeting the needs of our members across the country.

Referral Coordinator - Continuing Care Services (Montgomery)

Location: Portland, OR Job Number: 694999 Date posted: 05/18/2018
Description: Under direct and indirect supervision evaluates, manages, analyzes, and processes referral requests for Continuing Care Services (CCS) to determine the appropriate program for the patient.

Essential Responsibilities:
  • Under direct and indirect supervision, analyzes and processes referral requests for CCS to assure they meet established program criteria.
  • Receives and interprets referral requests, determines benefits and communicates this information to members, non-plan providers, NWP providers and other internal staff as appropriate.
  • Coordinates communications from contracted and non-contracted vendors related to the admission of KP members.
  • Contacts patients regarding receipt of referral and provide brief explanation of CCS programs, verify demographics and benefit information, and facilitates patient agreement to receive services from designated programs.
  • Processes non-clinical aspects of referrals to CCS including, insurance coverage, physician verification of NPI and PECOS, hospice attending physician, case assign clinicians, coordinates start of care date within each program-s regulatory requirements.
  • Effectively maintains daily accurate records of referrals to ensure patients are admitted to services in a timely manner.
  • Serves as a liaison between referring and program physicians, patients/families, department supervisors, managers, and CCS staff to ensure timely patient care.
  • Identifies and assists with timely transitions across programs.
    Under direct and indirect supervision, processes non-clinical aspects of referrals for CCS, Salem, Longview, and when programs are at capacity or require referral outsourcing.
  • Provides initial authorization when patients are outsourced.
  • Establish spot contracts when patients are outsourced to a non-core agency/facility.
  • Communicate effectively to ensure that patients referred out to outside agencies get care timely.
  • Provide patient information when requested by outsourced agencies.
  • Perform other duties as requested.

  • Basic Qualifications:
  • Minimum three (3) years demonstrated Medicare regulation experience pertaining to home care and facility care or equivalent experience.
  • Minimum one (1) year of demonstrated insurance and benefit plan experience.
  • High School Diploma or General Education Development (GED) required.
    License, Certification, Registration
  • N/A

    Additional Requirements:
  • Knowledge of Home Health and Hospice Medicare Conditions of Participation, The Joint Commission standards, Washington Administrative Code and Oregon Administrative Regulations.
  • Ability to work independently with indirect supervision, assimilates technical information, and maintains effectiveness in a busy environment.
  • Effective problem solving, analytical, and organizational skills as evidenced by past performance recognition.
  • Working knowledge of office machines, including PC-based computer systems (Windows), word processing, spreadsheet applications, data base applications.
  • Demonstrates excellent communication and customer-focused service skills as evidenced by past performance recognition.
  • Good written and verbal skills.
  • Thorough knowledge of medical terminology.

    Preferred Qualifications:
  • Minimum three (3) years processing referrals in home care or facility care.

  • Thorough knowledge of KP organization and structure.
  • Thorough knowledge of continuous process improvement principles, tools, and practices.
  • Working knowledge of KP computer systems including Healthconnect, common membership, and Tapestry.

    Primary Location: Oregon,Portland,Montgomery Park 2701 NW Vaughn St. Scheduled Weekly Hours: 24 Shift: Day Workdays: Mon, Tue, Wed, Thu, Fri, Sat, Sun Working Hours Start: Varies Working Hours End: Varies Job Schedule: Part-time Job Type: Standard Employee Status: Regular Employee Group/Union Affiliation: SEIU - Local 49 Job Level: Individual Contributor Job Category: Customer Services Department: Continuing Care Services Travel: Yes, 50 % of the Time
    Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status.

    External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances.
  • About Customer Service Careers

    Customer Service Careers

    With over 11 million members, more than 127,000 employees, and over 40 million doctor visits a year, our customer service teams need you to come work with a wide variety of people to address concerns, resolve grievances, and educate our communities about our offerings. At Kaiser Permanente, you'll put your communication and mediation skills to work in support of excellence. We are committed to supporting you with ongoing growth, training, and development opportunities.

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