PACE Referrals Specialist

Ignite Human Capital•Riverside, CA

2d•$22 - $32•Onsite

About The Position

The PACE Referrals Specialist coordinates referrals and follow-up care for PACE participants. The role receives, processes, schedules, and follows up on medical referral requests for diagnostic testing, medical specialists, and other providers, both in-house and outside. It serves as a key liaison among participants, families, clinic staff, providers, specialists, hospitals, and community resources, and supports timely, accurate access to care. This is a full-time, fully onsite position in Riverside, California, with a Monday–Friday schedule from 8:00 a.m. to 4:30 p.m. The organization is a private, nonprofit community health organization whose PACE program serves seniors through coordinated care intended to help them remain healthy at home and in their communities.

Requirements

High school diploma or GED.
At least one year of clinical or healthcare experience.
Valid Basic Life Support (BLS) certification, or willingness to obtain it if hired.
CPR and First Aid certification are required for all PACE employees; First Aid training is provided during onboarding and renewed annually.
Excellent verbal and written communication skills, with strong typing and proofreading skills.
Working knowledge of CPT, ICD-10, and medical terminology.
Ability to interpret written, oral, diagram-based, and schedule-based instructions.
Strong planning and organizational skills, including the ability to manage multiple tasks.
Ability to work independently and as part of a team.
Ability to handle highly confidential information professionally and ethically.
Ability to lift or carry 10 pounds.
Ability to stand for long periods.

Nice To Haves

Referral authorization and data processing experience.
At least one year of experience working with elderly populations.
Bilingual English/Spanish skills.

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 on time, including urgent and stat referrals.
Arrange transportation for participants attending internal and external medical appointments, including coordinating escorts.
Communicate referral details and appointment instructions to participants and their families.
Track referrals in designated logs and the electronic medical record (EMR).
Follow up on authorization requests, update their status in the EMR, and escalate issues until the referral loop is closed.
Complete surgery scheduling using appropriate CPT codes and coordinate related pre- and post-operative orders, labs, EKGs, and imaging.
Manage re-authorizations across payors in collaboration with clinical teams to prevent lapses or delays in care.
Review consultation reports for needed follow-up and work with providers to process follow-up promptly.
Partner with Health Information to retrieve consultation reports on time.
Reschedule missed appointments and notify providers according to no-show policies.
Arrange retrieval of CD images for specialists so appointments can be completed.
Submit retro-authorizations and distinguish between primary care and internal specialty visits.
Document all actions in participant records in accordance with clinic, DHCS, and CMS guidelines.
Explain the referral process to participants when needed or requested by the treating provider.
Handle referral-related calls, texts, patient portal messages, and mail.
Act as a liaison among participants, clinic providers, specialists, hospitals, and community resources.
Obtain referrals and authorizations from providers in a timely manner.
Communicate referral, authorization, and pertinent medical information to specialty providers.
Participate in scheduled department meetings.
Share accountability for participant health outcomes alongside care teams.
Maintain professional relationships with staff, participants, families, referral sources, and the public.
Work as part of a team to meet department goals.