Referrals Specialist-PACE

Neighborhood Healthcare•Riverside, CA

11h•Onsite

About The Position

Community health is about giving people the resources they need to live their best lives. At Neighborhood, the vision is a community where everyone is healthy and happy, providing care for each of life’s chapters. Neighborhood Healthcare PACE is a managed medical plan designed to surround participants with a team of physicians, nurses, social workers, therapists, and care coordinators to help them maintain good health and a good quality of life. The goal is to keep seniors happy and healthy at home, surrounded by family and community. As a private, non-profit 501(C)(3) community health organization, Neighborhood Healthcare serves over 500,000 medical, dental, and behavioral health visits from more than 100,000 people annually. With two PACE centers in Riverside County, the PACE program is positioned to serve over 650 senior participants. The Referrals Specialist will coordinate all referrals and follow-up care for PACE participants, 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.

Requirements

High school diploma/GED required
One year of clinical or healthcare experience required
Current Basic Life Support (BLS) certification is required upon hire and must be maintained as a condition of employment. These courses must follow AHA guidelines, but may be completed through approved online providers such as ProMed or other equivalent programs that meet recognized BLS standards
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
Ability to work with highly confidential information in a professional and ethical manner

Nice To Haves

Experience with referral authorization and data processing preferred
One year of experience working with elderly populations preferred
Bilingual (English/Spanish) highly preferred

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)
Follows up on submitted authorization requests and maintains consistent status updates via EMR
Monitors and reports on statuses of 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 specialist to ensure appointment are kept and completed
Submits 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 liaison between participant, clinic/providers, specialty care providers, hospitals, and other community resources
Obtains referrals and authorizations from providers in timely manner
Communicates referrals and authorizations information and pertinent medical information to the specialty provider
Participates in scheduled department meetings
Shares accountability for overall participant health outcomes, working in coordination with care teams
Maintains a professional working relationship with all levels of staff, clients, and the public
Cooperate, as part of a team, in accomplishing department goals and objectives
Maintains positive relationships with all participants, prospective participants, clinical staff, prospective employees, fellow co-workers and referral sources