PACE Referrals Specialist
PACE Referrals Specialist
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Job Description
Position Summary:
Responsible for timely processing documenting and follow up of referrals and request for treatment authorizations as requested by the primary physician and contracted network providers/vendors.
Essential Functions of the Job:
- Receives and processes referrals and approvals in alignment with the minimum expectations of CMS.
- In an expeditious manner reviews existing PACE network of providers coordinates and schedules specialty appointments as needed.
- Obtains approvals from providers and disseminates information to participants in writing or electronic media.
- Coordinates care within the guidelines of multiple providers.
- Responds to inquiries as to status of authorizations by assessing the request and evaluating the circumstances to provide the correct information.
- Initiates the appropriate documentation of requests from specialties offices for ongoing care.
- Followsup on missing documentation on submitted authorization requests to obtain sufficient information.
- Uses various modules of the computer system to obtain information query information and process orders and authorizations.
- Accurately documents on the various platforms and computer systems to ensure expeditious outcomes to all requested services.
- Communicates effectively with Providers and PACE participants while coordinating referrals and specialty appointments/services.
Additional Duties and Responsibilities:
- Maintains established departmental policies and procedures objectives quality assurance program safety and environmental.
- Enhances professional growth and development through participation in educational programs current literature inservice meetings and workshops.
- Attends meetings as required and participates in committees as directed.
- Performs other related duties as assigned or requested.
Job Requirements:
Education Required (Minimum level of education):
- High school diploma or GED equivalent
Certifications/Licenses Preferred:
- Medical Terminology CPC coding or Medical Assistant
Experience Required (Minimum level of experience):
- 2 years experience in the medical field OR
- Bachelors degree OR
- An equivalent combination of education and experience that provides the skills knowledge and ability to perform the essential job duties is required.
Experience Preferred:
- 2 years in health plan of clinic setting.
- One year of experience with Electronic Medical Record Systems.
Verbal and Written Skills Required to perform the Job:
- Excellent verbal and written communication skills.
Minimum Qualifications:
- Previous experience or strong desire to learn complex computer systems
- Technical proficiency with the Microsoft Office suite of applications.
- Demonstrated ability in resolving problems and communicating solutions verbally and/or in writing to the affected parties.
- Experience identifying and presenting information with tact and skill.
- Demonstrated critical thinking skills and consistent use of analytical and problemsolving skills.
- Demonstrated ability to be culturally sensitive and respect diversity.
- Detail oriented with strong time management and organizational skills
Technical Knowledge and Skills Required to Perform the Job:
- Medical terminology and basic computer.
- Typing of 35 wpm.
- Ability to handle multiple activities simultaneously.
- Be attentive to patient needs and concerns.
- Willing to work with others as a team member.
Equipment Used:
- Personal computer FAX eFAX TruChart Epic QuickCap Adobe Pro Microsoft office
Working Conditions and Physical Requirements:
- Prolonged sitting position walking constant telephone and email communication.
- May be required to work evenings holidays and/or weekends.
Universal Requirements
Pre employment requirements include I9 physical positive background and reference check results complete application new hire orientation preemployment PPDs.
About Us San Ysidro Health is a Federally Qualified Health Care organization committed to providing high quality compassionate accessible and affordable healthcare services for the entire family. The organization was founded by seven women in search of medical services for their families and community. Almost 50 years later San Ysidro Health now provides innovative care to over 108000 patients through a vast and integrated network of 47 program sites across the county. San Ysidro Health could not serve our patients without the dedication of our passionate and hardworking employees. Apply today and become a part of our missiondriven team! San Ysidro Health has a longstanding commitment to equal employment opportunity for all applicants for employment. Employment decisions including but not limited to those such as employee selection performance evaluation administration of benefits working conditions employee programs transfers position changes training disciplinary action compensation and separations are made without regard to race color religion (including religious dress and grooming) creed national origin nationality citizenship status domestic partnership status ancestry gender affectional or sexual orientation gender identity or expression marital status civil union status family status age mental or physical disability (including AIDS or HIVrelated status) atypical heredity cellular or blood trait of an individual genetic information or refusal to submit to a genetic test or make available the results of a genetic test military status veteran status or any other characteristic protected by applicable federal state or local laws.
Other details
- Pay TypeHourly
- Min Hiring Rate$25.11
- Max Hiring Rate$32.42
Required Experience:
Unclear Seniority
Employment Type
Hourly
