Referrals Specialist-PACE

Requirements

• 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
• Cooperates, 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

Benefits

• Partially company paid Medical, Dental, and Vision Plans
• Two plus weeks of vacation
• Nine Holidays including two Floating Holidays of your choosing
• Sick/Personal time
• Volunteer Time Off (VTO)
• 403b Retirement plan (similar to a 401k)
• Optional Health and Wellness events