Referrals Specialist

Experience:

Mid Level Salary:

$21 - $32 per hour Job Details - Job Details We are seeking a dynamic and experienced Consulting Referrals Specialist to join our team in the healthcare industry. This role is pivotal in coordinating all referrals and follow-up care for PACE participants. The specialist will be responsible for receiving, processing, scheduling, and following up on all medical referral requests, including in-house and outside referrals for diagnostic testing, medical specialists, or other providers. Responsibilities Serve as the main point of contact for providers and clinic staff regarding referrals, authorizations, and appointment scheduling. Prepare, process, and complete referrals accurately and in a timely manner, including urgent and stat referrals for assigned PACE location. Arrange transportation for participants to medical appointments at Neighborhood and other organizations, including escort coordination. Communicate referral details and appointment information/instructions to participants and their families. Track referrals in the designated logs and/or electronically via electronic medical records (EMR). Follow up on submitted authorization requests and maintain consistent status updates via EMR. Monitor and report on statuses of authorization requests; escalate issues as necessary until fully resolved and referral loop is closed. Complete surgery scheduling with proper CPT codes and all needed follow-ups, including pre and post order management, labs, EKG, images, etc. Manage 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. Advocate and discuss with participants all aspects of the referral process as needed or requested by the treating provider. Screen and answer related referral calls by telephone, text message, patient portal, and/or by mail. Act as a liaison between participant, clinic/providers, specialty care providers, hospitals, and other community resources. Qualifications High school diploma/GED required. One year clinical or healthcare experience required. Experience with referral authorization and data processing preferred. One year experience working with frail and elderly populations preferred. Bilingual (English/Spanish) required. Excellent verbal and written communication skills, including superior composition, typing and proofreading skills. Ability to interpret a variety of instructions in written, oral, diagram, or schedule form. Knowledgeable about and experience with current procedural terms (CPT), international classification of diseases (ICD-10), and medical terminology. Ability to successfully manage multiple tasks simultaneously. Excellent planning and organizational ability. Ability to work as part of a team as well as independently. The ideal candidate must have 5+ years of experience in a similar role. If you have the necessary skills and experience, we encourage you to apply.

A bit about us:

- Prestige Hospital System Placed #1 in both California in a broad assessment of excellence in hospital-based patient care. Why join us? - Competitive Salary$$ Stellar Benefits (Medical, Dental Vision, Life Insurance) Flexible Schedule Job Stability Career growth The position offers a competitive salary If you are passionate, thrive in a fast-paced environment and are ready to take your career to the next level, we would love to hear from you. #healthcare #healthcare #um #cpt #fqhc #referrals #prior-authorization #authorizations #icd-10-coding #pace-geriatric #tier1