PACE Referrals Specialist

San Ysidro Health•San Diego, CA

About The Position

Responsible for timely processing, documenting, and follow up of referrals and request for treatment authorizations as requested by the primary physician and contracted network providers/vendors.

Requirements

High school diploma or GED equivalent
2 years’ experience in the medical field, OR
Bachelor’s degree, OR
An equivalent combination of education and experience that provides the skills, knowledge, and ability to perform the essential job duties is required.
Excellent verbal and written communication skills.
Previous experience or strong desire to learn complex computer systems
Technical proficiency with the Microsoft Office suite of applications.
Demonstrated ability in resolving problems and communicating solutions verbally and/or in writing to the affected parties.
Experience identifying and presenting information with tact and skill.
Demonstrated critical thinking skills, and consistent use of analytical and problem-solving skills.
Demonstrated ability to be culturally sensitive and respect diversity.
Detail oriented with strong time management and organizational skills
Medical terminology and basic computer.
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.

Nice To Haves

Medical Terminology, CPC, coding, or Medical Assistant
2 years in health plan of clinic setting.
One year of experience with Electronic Medical Record Systems.

Responsibilities

Receives and processes referrals and approvals in alignment with the minimum expectations of CMS.
In an expeditious manner, reviews existing PACE network of providers, coordinates and schedules specialty appointments as needed.
Obtains approvals from providers and disseminates information to participants in writing or electronic media.
Coordinates care within the guidelines of multiple providers.
Responds to inquiries as to status of authorizations by assessing the request and evaluating the circumstances to provide the correct information.
Initiates the appropriate documentation of requests from specialties offices for ongoing care.
Follows-up on missing documentation on submitted authorization requests to obtain sufficient information.
Uses various modules of the computer system to obtain information, query information and process orders and authorizations.
Accurately documents on the various platforms and computer systems to ensure expeditious outcomes to all requested services.
Communicates effectively with Providers and PACE participants while coordinating referrals and specialty appointments/services.
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.