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Posted on 06/06/2017

Referrals Specialist

San Ysidro Health Center - San Diego, CA

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Job Description

Responsible for timely processing, documenting, scheduling and follow up of referrals and request for treatment authorizations as requested by the primary physician.

Essential Functions of the Job:

  • Receives and processes referrals and authorizations in a timely manner.  Schedules all requests for referrals and treatment authorizations.
  • Schedules appointments for specialty care, special studies or other ancillary services as requested by the PACE physicians.
  • Obtains approvals from providers and disseminates information to participants in writing or electronic media.
  • Provide call reminders to participants about scheduled appointments. Makes outreach calls to patients missing appointments based on preventative and chronic disease guidelines. Makes calls to providers to verify completion of appointments and opportunities for follow ups
  • Schedules transportation for participants within the parameters of their daily routine.
  • Coordinates care within the guidelines of multiple providers or contracts.
  • Responds to inquiries as to current status of authorizations by assessing the request and evaluating the circumstances to provide the correct information.
  • Initiates the appropriate documentation for requests from specialists offices for ongoing care.
  • Follow-up on missing documentation to obtain authorization or scheduling when appropriate.
  • Use various modules of the computer system to obtain information, schedule appointments, query information and process authorizations.
  • Works with participant’s family/caregiver as needed for medical appointments. Coordinates caregiver services as needed.
  • Follows up on medical appointments and works with participant/family member or caregiver for any special indications regarding participant care and/or treatment.

Additional Duties and Responsibilities

  • Maintains established departmental policies and procedures, objectives quality assurance program, safety and environmental.
  • Enhances professional growth and development through participation in educational programs, current literature, in-service meetings and workshops.
  • Attends meetings as required and participates in committees as directed.
  • Performs other related duties as assigned or requested

Job Requirements

Education Required (Minimum level of education): 

  • High school diploma or GED equivalent.
  • Preferred: Current Procedural Coding (CPC).

Certifications/Licenses Required: 

  • Medical Terminology, CPC or Medical Assistant
  • Certificate or a minimum of 2 years on the job experience processing referrals
  • Valid California Driver’s License.

Experience Required (Minimum level of experience): 

  • 2 years in medical field to include front or back office or referral authorization knowledge of programs and health plans eligibility and guidelines, coding and data processing.
  • Preferred: 2 years in primary care setting. One year of experience with Electronic Medical Record Systems.

Verbal and Written Skills Required to Perform the Job: 

  • Bilingual (Spanish/English) preferred.
  • Good verbal and written communication skills in both languages preferred. 

Technical Knowledge and Skills Required to Perform the Job: 

  • Medical terminology and basic computer skills. 
  • Typing of 35 wpm. 
  • Ability to handle multiple activities simultaneously. 
  • Be attentive to patient needs and concerns. 
  • Willing to work with others as a team member.

Equipment Used : 

  • Personal computer, Nextgen, FAX, InetMD, TruChart.

Working Conditions and Physical Requirements: 

  • Prolonged sitting position, walking, constant telephone communication

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