Referrals Specialist (Campo, CA - Onsite)

San Ysidro Health•Campo, CA

1d•Onsite

About The Position

Under the direct supervision of the Referrals Supervisor, the Referrals Specialist is responsible for the timely processing, documenting, scheduling and follow up of referrals and request for treatment authorizations as requested by the primary physician. Essential Functions of the Job: Receives and processes authorizations in a timely manner with attention to quality, accuracy, and completeness of work. Schedules requests for referrals and treatment authorizations. Obtain authorizations from various insurance carriers via phone, in writing or email/fax, adjusting effectively to organizational changes. Follows-up on missing documentation to obtain authorization when appropriate. Schedules appointments for specialty care, special studies, Durable Medical Equipment (DME) or other ancillary services as requested by the primary care physician. 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 as to statuses of authorizations by assessing the request and evaluating the circumstances to provide regular, consistent, timely, and meaningful information to our patients. Demonstrates professionalism verbally and non-verbally and tailors communication styles to the need of the recipient. Listen to patient’s concerns, via phone or in-person, and address their needs accordingly. Seeks different points of view and leverages diverse perspectives. Meets established or agreed upon deadlines. Work on closing the referrals loop; review the referral log weekly to determine which patients have kept their specialty or consultation appointments. Update referrals with the date and time of appointments. Document if the patient kept their appointment, reach out to Specialist or Facility to request visit notes or results to be faxed to Referrals main fax number within 5 working days of visit. Additional Duties and Responsibilities: Maintains established departmental policies and procedures. Enhance professional growth and development through continued education and training. Working at different sites/locations is required based on business and staffing needs or for trainings as deemed necessary. 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. Use a solutions-based approach to help improve processes and workflows. Performs other related duties as assigned or requested by Supervisor or Manager.

Requirements

High School Diploma or GED, or 3 or more years of relevant work experience in lieu of education.
CA driver’s license and an insured vehicle – local travel is required as necessary for business needs, such as staffing coverage and required training.
A minimum of 6 months experience working in a healthcare setting to include both front and back office and/or referral authorization experience, as well as knowledge of different health plans, programs, and eligibility guidelines, and at least 2 years of customer service experience.
Bilingual (Spanish/English) is required.
Excellent verbal and written communication skills.
Knowledge of basic medical terminology.
Basic medical terminology and computer skills.
Microsoft Office experience (Word, Excel, Outlook) is a plus.
Understanding of electronic medical records systems.
Typing 35 wpm.
Ability to multi-task and prioritize tasks based on urgency.
Be attentive to patient needs and concerns.
Ability to work independently as well as with a team.
Pre-employment requirements include I-9, physical, positive background and reference check results, complete application, new hire orientation, pre-employment PPDs.
Compliance with all mandated vaccinations and all boosters is a term and condition of employment.

Nice To Haves

Coding and Data Processing or Medical Assistant Certificate are helpful.
Experience with EPIC is a plus.

Responsibilities

Receives and processes authorizations in a timely manner with attention to quality, accuracy, and completeness of work.
Schedules requests for referrals and treatment authorizations.
Obtain authorizations from various insurance carriers via phone, in writing or email/fax, adjusting effectively to organizational changes.
Follows-up on missing documentation to obtain authorization when appropriate.
Schedules appointments for specialty care, special studies, Durable Medical Equipment (DME) or other ancillary services as requested by the primary care physician.
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 as to statuses of authorizations by assessing the request and evaluating the circumstances to provide regular, consistent, timely, and meaningful information to our patients.
Demonstrates professionalism verbally and non-verbally and tailors communication styles to the need of the recipient.
Listen to patient’s concerns, via phone or in-person, and address their needs accordingly.
Seeks different points of view and leverages diverse perspectives.
Meets established or agreed upon deadlines.
Work on closing the referrals loop; review the referral log weekly to determine which patients have kept their specialty or consultation appointments.
Update referrals with the date and time of appointments.
Document if the patient kept their appointment, reach out to Specialist or Facility to request visit notes or results to be faxed to Referrals main fax number within 5 working days of visit.
Maintains established departmental policies and procedures.
Enhance professional growth and development through continued education and training.
Working at different sites/locations is required based on business and staffing needs or for trainings as deemed necessary.
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.
Use a solutions-based approach to help improve processes and workflows.
Performs other related duties as assigned or requested by Supervisor or Manager.