Referrals Specialist-PACE

Responsibilities

• Serves as the main point of contact for providers and clinic staff regarding referrals, authorizations, and appointment scheduling
• Prepares, processes, and completes referrals accurately and in a timely manner, including urgent and stat referrals for assigned PACE location
• Arranges transportation for participants to medical appointments at Neighborhood and other organizations, including escort coordination
• Communicates referral details and appointment information/instructions to participants and their families
• Tracks referrals in the designated logs and/or electronically via electronic medical records (EMR)
• Maintains consistent status updates via EMR on submitted authorization requests
• Escalates issues as necessary until fully resolved and referral loop is closed
• Completes surgery scheduling with proper CPT codes and all needed follow-ups, including pre and post order management, labs, EKG, images, etc.
• Manages needs for re-authorization across all clients and payors by working with clinical teams to ensure timeliness re-authorization ahead of expiry to avoid lapses in authorization or delays in patient care
• Reviews consultation reports for needed follow-up requests and works with providers to ensure timely processing of all follow-ups
• Works with the health information department to ensure timely retrieval of consultation reports
• Reschedules missed appointments and notifies the provider according to no-show policies
• Arranges the retrieval of CD images and provides to medical specialists to ensure appointments are kept and completed
• SUBMITTERS RETRO-AUTHORIZATIONS AND DISTINGUISHES BETWEEN PRIMARY CARE AND INTERNAL SPECIALTY VISITS
• DOCUMENTS ALL ACTIONS TAKEN IN THE PARTICIPANT MEDICAL RECORD IN ACCORDANCE WITH CURRENT CLINIC, DHCS AND CMS REGULATIONS/GUIDELINES
• ADVOCATES AND DISCUSSES WITH PARTICIPANTS ALL ASPECTS OF THE REFERRAL PROCESS AS NEEDED OR REQUESTED BY THE TREATING PROVIDER
• Screens and answers related referral calls by telephone, text message, patient portal, and/or by mail
• ACTS AS A LIASON BETWEEN PARTICIPANT, CLINIC/PRACTITIONERS, SPECIALTY CARE PROVIDERS, HOSPITALS, AND OTHER COMMUNITY RESOURCES

Qualifications

• High school diploma/GED required
• One year of clinical or healthcare experience required
• Experience with referral authorization and data processing preferred
• One year of experience working with elderly populations preferred
• Bilingual (English/Spanish) highly preferred
• Current Basic Life Support (BLS) certification required upon hire and must be maintained as a condition of employment
• Knowledgeable about and experience with current procedural terms (CPT), international classification of diseases (ICD-10), and medical terminology
• Excellent verbal and written communication skills, including superior composition, typing, and proofreading skills
• Excellent planning and organizational ability
• Ability to work as part of a team as well as independently
• Ability to work with highly confidential information in a professional and ethical manner

Physical Requirements

• Ability to lift/carry 10 lbs/weight
• Ability to stand for long periods of time

Benefits

• Partially company paid Medical, Dental, and Vision Plans
• Two plus weeks of vacation
• Nine Holidays including two Floating Holidays of your choosing
• Sick/Personal time
• Volunteer Time Off (VTO)
• 403b Retirement plan (similar to a 401k)
• Optional Health and Wellness events
• and much more!

Pay

Pay range: $22.88-$32.08 per hour, depending on experience.