Referrals Specialist Lead (San Ysidro, CA)

San Ysidro Health•San Diego, CA

11d•$30 - $38•Hybrid

About The Position

The Referrals Specialist Lead provides assistance in monitoring the functions of the Referral Specialist. This role works closely with the Referrals Department Supervisor and Manager to assure the quality improvement goals, objectives, appropriateness, and timeliness of the referral process are met on a day-to-day basis, as well as providing guidance to the team when needed. The Lead is contacted for troubleshooting on patient or provider inquiries/concerns and any barriers to compliance. This role acts as the lead contact to address concerns and questions for other Referral Specialists in the department. When necessary, the Lead assists in implementing changes in the workflow to improve the processing of referrals and monitors appropriate coding and documentation of referral activity.

Requirements

High school diploma or GED equivalent.
Valid CA driver’s license and access to an insured vehicle.
A minimum of 1 year experience in healthcare setting to include front with back office or referral authorization knowledge of programs and health plans eligibility and guidelines.
Local travel to other clinics is required.

Nice To Haves

Coding, data processing, or a Medical Assistant certification preferred.

Responsibilities

Assists Referral Specialists in managing difficult cases to obtain appropriate care for the patient.
Acts as lead contact to address concerns and questions for other Referral Specialists in the department.
Assists in implementing changes in the workflow to improve the processing of referrals.
Assists in monitoring appropriate coding and documentation of referral activity.
Receives and processes authorizations in a timely manner with the utmost attention to quality, accuracy, and completeness of work.
Plans in advance to ensure tasks are complete and seeks to add value to every work assignment.
Schedules requests for referrals and treatment authorizations.
Demonstrates skills and knowledge to obtain authorizations from various insurance carriers via phone, in writing, or electronic media, adjusting effectively to organizational changes while maintaining high standards.
Coordinates care within the guidelines of multiple health plans, contracts, or insurance types.
Uses various modules of the computer system to obtain information, schedule appointments, query information, and obtain authorizations.
Responds to inquiries regarding the current status of authorization by assessing the request and evaluating the circumstances to provide regular, consistent, timely, and meaningful information to patients.
Demonstrates professionalism verbally and non-verbally, tailoring communication styles to the needs of the recipient.
Listens to customers (internal and external) and addresses needs; is accountable and responsive to customer concerns.
Seeks different points of view and leverages diverse perspectives.
Meets established or agreed-upon deadlines.
Arrives on time and prepared for work; uses sound judgment to meet and exceed workplace expectations; assumes responsibility and accountability for decisions, actions, and performance.
Works on closing the referrals loop; reviews the referral log weekly to determine which patients have kept their specialty or consultation appointments and shares this with the team.
Updates the referral with the date and time of the appointment.
Documents if the patient kept their appointment, reaches out to the Specialist or Facility to request visit notes or results to be faxed to the Referrals main fax number within 5 working days of the visit.
Manages the Referrals Team and provides effective guidance.
Is responsible for leading, guiding, training, and motivating team members on a daily basis.
As a team leader, is the contact point for all team members, requiring excellent communication skills.
Is able to act proactively to ensure smooth team operations and effective collaboration.
Creates an inspiring team environment with an open communication culture.
Sets clear team goals.
Delegates tasks and sets deadlines.
Oversees day-to-day operations.
Monitors team performance and reports on metrics.
Motivates team members.
Discovers training needs and provides coaching.
Listens to team members’ feedback and resolves any issues or conflicts.
Keeps Supervisor informed and updated.
Recognizes high performance and rewards accomplishments.
Encourages creativity.
Suggests and organizes team building activities.
Runs/monitors daily and weekly referrals reports to ensure referrals are being processed within the respective timeframe.
Assists in preparing productivity reports requested by Supervisor/Managers on a daily basis for monitoring and/or for audits as needed.
Assists with the training of new staff and existing Referral Specialists with technical updates and guidance to maintain quality measures to San Ysidro Health standards.
Provides guidance to new hires with orientation to Policies and Procedures, onboarding, and provides regular updates to Supervisor/Manager on new staff.
Assists in preparing presentations for monthly meetings and creates handbooks for training purposes as needed.
Assists with workload distribution to ensure necessary coverage when needed.
Monitors co-workers' daily duties, workflows, and creates workload assignation schedules.
Monitors project workloads and coordinates workflow.
Helps with the IRR for staff to have the same training tools and trainable referral knowledge.
Supports the interviews process for new hires by facilitating the typing test and welcoming the candidate for a smooth, successful interviewing process.
Fosters and upholds office standards above satisfactory level, including efficiency of service to patients and co-workers.
Performs weekly morning huddles with the Team to provide updates and receive feedback from staff, sharing with Supervisor/Manager for guidance as needed.
Assists in providing any assistance on gathering valuable data when needed for PCMH or any other programs as required or requested.
Leads by setting a good example and engages the team to achieve goals.
Maintains established departmental policies and procedures.
Displays and promotes behavior consistent with SY Health; adheres to standards of ethical conduct and professional compliance.
Enhances professional growth and development through participation in educational programs, current literature, in-service meetings, and workshops; models a high-performance work ethic and constant self-improvement.
Attends meetings as required and participates in committees as directed.
Works cooperatively with others to meet shared objectives.
Fosters an environment that encourages group participation and inclusiveness.
Takes initiative to improve processes and identify root causes, maintaining a focus on solutions.
Performs other related duties as assigned or requested by Supervisor and/or Manager.