Referral Specialist

About the role

Join the Team Voted Best Place to Work in North County! Why Work for Gary and Mary West PACE? Because you desire work/life balance and have a passion to make a difference in the lives of North County seniors and their families!

You will receive generous pay and a benefits program focused on your health and wellness that includes 11 paid holidays, 13 days of PTO plus 5 days of sick time, a 5% employer-match to our 403b retirement program, and no on-call time.

Responsibilities

• Receives and processes referrals and authorizations in a timely manner.
• Congnates care with primary care providers and their clinical coordinators in obtaining the necessary documentation needed for outsourced care and diagnostics/radiology.
• Interfaces with specialty offices to answer questions in regards to referral and authorization statuses.
• Able to navigate and utilize multiple functions from an electronic medical record platform in producing a comprehensive referral that will satisfy the needs of specialists.
• Able to use clinical and administrative judgement under regulations to determine best approach for both urgent and non-urgent patient care needs.
• Maintain HIPAA standards and adhere to policies and procedures that govern the confidentiality of healthcare sensitive information.
• Requests additional medical records from specialty offices and clinic for further review by Utilization and Network Manager and/or PACE Medical Director as needed.
• 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.
• Ability to multi-task, be flexible, ensure accuracy, and meet changing priorities in a fast-paced, high-workload environment.
• Ability to work with others as a core centralized team in addition to maintaining good interpersonal interactions with clients as a member of a multi-disciplinary community health team with a diverse multi-cultural population.
• Adheres to Gary and Mary West PACE core values and behaviors of Excellence, Empowerment, Integrity, and Respect.
• Performs other duties as required or requested in a positive and helpful manner to ensure a smooth-running work area.
• Adheres to all GMWP Policies and Procedures, GMWP Safety Policies and Procedures and OSHA safety guidelines.
• Must demonstrate regular attendance and punctuality.
• Buys issues and process improvement ideas to the attention of the Supervisor.
• Completes annual trainings as required.
• Adheres to Company Dress Code Policy.
• Demonstrates appropriate level of time management in support of co-workers and the entire team.

Requirements

• High school diploma or GED equivalent required.
• Medical Terminology Certification preferred.
• Medical Assistant Certificate preferred.

Qualifications

• One year of health care experience working with frail and/or chronically ill elderly population.
• One year experience in a healthcare setting including front and back-office exposure.
• One year experience in referral and authorization processes for managed care insurance platforms.

Skills and Experience

• Able to demonstrate excellent written and verbal communication skills and the ability to interact clearly and effectively with both internal and external customers.
• Prior exposure working with and electronic medical record platform.
• Proficient in Microsoft Word and Excel.
• Skilled in establishing and maintaining effective working relationships with participants, co-workers, vendors, medical staff, and the public.

Education and Certification

• High school diploma or GED equivalent required.

Benefits

Includes 11 paid holidays, 13 days of PTO plus 5 days of sick time, a 5% employer-match to our 403b retirement program, and no on-call time.

Pay

$23.00 per hour