Career Listings

This position will work under the supervision of the Billing Manager.  The Billing Specialist will be responsible for the completion of all tasks to ensure accurate, compliant and timely billing of patient charges for appropriate reimbursement from all sources, such as patients and all other third party payers.   Billing Specialists will interact with a multi-cultural population of diverse socioeconomic backgrounds, ages, and level of education.

The Billing Specialist is responsible for performing the following duties:

• Reviews charges, payments and adjustments to ensure accuracy and compliance with billing, coding and any contractual requirements
• Generates paper or electronic claims and submits them to all third party payers such as Medi-cal Medicare, private insurances and other programs
• Generates patient statements and collection letters
• Enters payments received from payers and patients in the practice management system
• Reviews claim rejection queue and resolves for resubmission
• Follows up on denied and unpaid claims; works closely with payersto provide any information necessary to receive payment
• Reviews and collects on overdue patient balances
• Answers questions from patients, staff and payers
• Reviews and processes requests for adjustments, corrections or refunds
• Prepares billing reports
• Collaborates and communicates with other team members to ensure efficiency of processes
• Maintains billing records
• Performs other duties as assigned including participation in all safety programs which may include assignment to an emergency response team.

Under the direction of the Claims Supervisor, the claims processor is responsible for receiving claims and processing adjudicating the claims in an expedient manner. Responsible for provider claims verification and adjudication. Responsible for meeting the performance measurement standards for productivity and accuracy cor the specifics claims. HCFA and UB.Ensure the privacy of security of PHI, as outlined in health plans and policies relating to HIPAA compliance.

The Claims Examiner is responsible for the following:

• Verifying and adjudicating provider claims in moderate complexity categories.
• Adjudicate all professional and outpatient facility claims including Coordination of Benefits, denials, and reduction in service notifications.
• Responsible for meeting or exceeding production and quality standards for specific types of claim forms, professional (HCFA) and/or institutional (UB).
• Route claims that cannot be finalized.
• Research, resolve, and respond to inquiries and problems of a moderately complex nature.
• Follow documented claims policies and procedures.
• Interface with other departments, when necessary, regarding claims issues.
• Participate in Claims Department staff meetings, and other activities as needed.
• Ensure the privacy and security of PHI (Protected Health Information) as outlined in health plans policies and procedures relating to HIPAA compliance.
• May be responsible for mentoring newer associates.
• Perform other duties as assigned including participation in all safety programs which may include assignment to an emergency response team.

The Database Administrator is responsible for systems administration and data management tasks.  Ensures proper and timely communication and resolution of system issues. Provides systems support to clinic sites and operations users; troubleshooting and recovery of EHR workstation functionality. Supports patient processing, clinical tracking and reporting activities; works with medical providers and Information Technology (IT) staff and recommends changes to database management systems and templates. Responsible for training of employees on system use, proper access to the corporate network, use of application software and other related clinical software. The DBA will adhere to and promote compliance with the organization’s Information Technology policies and procedures and will rely on instructions and pre-established guidelines to perform the duties and responsibilities of the job. Performs other duties as assigned including participation in all safety programs which may include assignment to an emergency response team.

Under the general supervision of the Outreach Coordinator, Health Center Manager, and oversight of the Director of Health Education and Prevention Programs, the Enrollment Specialist performs a variety of registration and financial screening functions with the objective of determining eligibility for medical care coverage under the terms of various private and public health care and financial services assistance programs. This position will be primarily entail evening and weekend work out in the community. The Enrollment Specialist is responsible for performing the following duties: • Researches and verifies patient eligibility for different programs and insurance coverage • Registers and interviews patients to obtain accurate and complete demographic and financial information. • Informs patients about the availability of governmental funded and discount programs. • Properly completes enrollment applications through electronic and manual systems. • Provides case management services for individuals and families on public and private health insurance programs. • Provides excellent customer service to patients, vendors and employees. • Must have reliable transportation to be used during working hours for off-site appointments and outreach activities.

• Provide nursing care to clinic patients • Prepare patients physically and psychologically for treatment examinations, and scheduling diagnostic studies • Teach patients to care for their particular needs • Responsible for recognizing and interpreting symptoms and reporting condition of patients to the attending physician • Responsible for keeping inventory of stock medicines available and making drug and medical supply orders bimonthly or as needed • Administer treatments and medication under physician’ orders • Responsible for preparing in-house monthly reports as well as immunization report • Provide supervision of appropriate personnel, coordinate patient flow activities and assist with peer review of patient records in their quality of care system.

The Operations Manager reports to the Chief Operations Officer and will be responsible for overseeing the day-to-day management and operation of satellite clinic(s). The Operations Manager will implement the policies and procedures of the organization and work towards enhancing the development of clinic practices. Select, train, and supervise Health Center managers and employees. Assist in budget development and act as a liaison with local funding sources. Provide public relations representation at community functions and assist in the development and maintaining of corporate goals.

The Provider Services Specialist has significant responsibility for implementing and maintaining contractual agreements with health care providers and institutions within state and federal regulatory requirements. Provides high-level professional customer service to the Clinicas contracted provider network, including but not limited to, physicians and ancillary providers. This position works closely with Clinicas management team to make Clinicas the "provider network of choice" among physicians, hospitals and other health care professionals.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES The Provider Services Specialist responsibilities include, but are not limited to: Coordinate and maintain strong relationships between Clinicas and its network providers Respond to general provider inquiries regarding network participation and member coordination Serves as a liaison between specialty network providers, health plans and CDCR departments in resolving issues and problems Communicate Clinicas policies/issues to physicians, hospitals and other health care professionals Manage processes to assure consistency in Clinicas contractual agreements with its provider constituency, including credentialing requirements, mandatory annual trainings and provider surveys Arranges provider education and training of contracted health care providers and office staff on managed care concepts and Clinicas policies and procedures as they apply Work with Clinicas Medical Management team to provide education and training for health care providers and office staff on Clinicas managed care requirements and effective use of provider portal Work with Provider Services staff to assure smooth and efficient operations Answer provider claims inquiries Uses automated database and tracking systems to retrieve and update information and generate reports related to provider relation activities Develop and communicate training materials designed to educate office staff Manage Provider Database in MSO software application Composes correspondence, conducts research and prepares reports as needed Perform other duties as assigned including participation in all safety programs which may include assignment to an emergency response team.

Clinicas Del Camino Real, Inc. has been providing quality primary and preventative health care services to the residents of Ventura County since 1971. We have an exciting opportunity for a Referral Coordinator, to work in our Referrals department in Camarillo, CA

The Referral Coordinator is essential in obtaining medically appropriate services inside and outside of Clinicas del Camino Real, Inc. Patient needs, including referral to a Specialist, are identified by the Clinicas practitioner and processes through an established referral system.  The Referral Coordinator expedites the administrative requirements for patient referrals, ensuring that appropriate referrals are made to participating providers within the patient’s health plan.

• Obtains appointments for Specialist visits and notifies patients of appointments.
• Acts as a resource regarding referrals and insurance plan guidelines. • Interprets medical guidelines, benefits, policies and procedures in support of their objective to expedite the referral process.
• Knowledgeable about the regulations of various payer sources including, but not limited to: Self Pay, Private Insurance, Medi-Cal, Medicare, Medi-Cal & Insurance Managed Care/HMO, Children’s Health and Disability Prevention (CHDP), Healthy Families, Family PACT, and California Children’s Services (CCS). Knowledgeable about the regulations regarding these various payer sources.
• Manages member/patient and provider inquiries regarding referral status, the authorization process and other issues in a courteous and professional manner.
• Data entry of authorization into Electronic Health Records and /or Utilization Review system, ensuring that all referrals are tracked through to a completed visit and a report is received.
• Collaborates with Providers, Health Center Nurses/Medical Assistants, and UM Nurses to obtain additional medical information and notifies UM Nurse of potentially urgent requests.
• Processes all referral requests according to Clinicas’ policies and procedures.
• Verifies member eligibility via insurance carrier and/or Medi-Cal web portal
• Participates in the introduction and implementation of new procedures.
• Makes recommendations regarding changes, improvements, or enhancements to appropriate staff.
• Assists with training and orienting new employees, as assigned.
• Coordinates and assists with obtaining surgery appointments and re-scheduling missed appointments as needed.
• Notifies patients of authorization status, as needed.
• Distributes denial letters to appropriate recipients.
• Attends meetings as assigned.
• Provides excellent customer service to patients, vendors and employees.
• May assist patients with mental illness, substance abuse problems and or/emotional disturbance.
• Due to the nature of the job, may work with or be exposed to information or material of a sexual nature.
• Performs other duties as assigned including participation in all safety programs which may include assignment to an emergency response team.

This Position will be under the supervision of the Call CenterManager. The scheduling clerk will have the responsibility to: • Answer and greet patient's calls • Schedule patients • Help determining patients’ eligibility and ensures guidelines and frequency limitations are followed • He/she will be responsible for following clinic policies, particularly those related to front desk procedures all in a call center setting.

We are currently seeking a Purchasing Technician to work in the Purchasing unit of our Ventura Health Center. Under the Supervision of the Controller/Finance Manager, the Purchasing Technician performs the following duties: Assists the Purchasing Agent with soliciting for goods and services via the Purchase Order system. Assists in the selection of vendors based on their capabilities, performance, payment terms, quality of product or service, and purchase price. Reviews all requisitions for conformity and approval of manager before placement of order. Prepares and processes purchase orders to include contract price of each item. Handles back order items and pricing discrepancies in a timely manner. Matches receivers/packing slips to purchase orders and submitted to accounting. Maintains and files purchase order files in standard order. Maintains record of employee pagers and cellular phones. Answers questions from both the field and from vendors and follows up on back orders in a timely manner. Handles returned items properly and seeks credit memo for item as appropriate. When the Purchasing Agent is absent, the Technician will be their backup and perform their tasks as necessary. Assists the Finance Unit on other projects as needed. Adheres to established policies and procedures. Interacts in a professional manner and works collaboratively with Clinicas’ staff, management and peers Perform other duties as assigned including participation in all safety programs which may include assignment to an emergency response team.