PACE Referrals Specialist (El Cajon, CA)

875 El Cajon Blvd, El Cajon, CA 92020, USA Req #5872

Wednesday, June 21, 2023

Position Summary:

Under the direction of the Referrals Supervisor, the Referrals Coordinator serves as the main point of contact for providers and clinic staff, regarding referrals, authorizations and appointment scheduling. Responsible for timely processing, documenting, and follow up of referrals and authorizations, as requested by the primary physician. Ensures that scheduling requirements and participants scheduling preferences are met.

Essential Functions of the Job:

• Serve as the main point of contact for providers and clinic staff, regarding referrals, authorizations and appointment scheduling.
• Receives and processes referrals and approvals in a timely manner from ALL PACE locations.
• Process the urgent and stat referrals for their assigned PACE location.
• Ensures that external providers receive authorizations by calling, emailing and or faxing.
• Call the external provider to confirm that authorization was received.
• Verify via phone that the requested external provider is within our network.
• Gather all the necessary information on external provider, to proceed with authorization.
• Maintain a close communication with clinical team.
• Sends Authorization Approval Letter to participant via mail.
• Send notice to SW when Authorization Letter is sent back for incorrect address.
• Responds to inquiries as to current status of authorizations and specialist appointments by assessing the request and evaluating the circumstances to provide the correct information.
• Uses various modules of the computer system to obtain information, schedule appointments, query information and process authorizations.
• Ensure all appointments are scheduled appropriately and according to participant needs and care plan specifications.
• Assures all necessary appointment records are maintained according to policy.
• Coordinates with the different disciplines, to address any participant needs such as transportation, companionship and translation.
• Properly documents in electronic health record, all appointments, communication, and relevant information regarding participants’ appointments, follow ups, companionship, translation and transportation needs.
• Coordinate with the transportation team when there is a need to request last minute transportation.
• Provides high level of customer service.
• Provides translation, verbal or written as necessary, if bilingual.
• Works in Services Coordination with other disciplines & patients as needed.
• Positively impacts patient experience by demonstrating values of Transforming Care including, but not limited to courteous and helpful behavior and a commitment to accuracy.
• Shares accountability for overall patient health outcomes, working in coordination with Care Teams.
• Operates to instill confidence in our care and in our facilities to patients, fellow employees, and other stakeholders.
• Other duties as assigned.

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, in-service meetings and workshops.
• Attends meetings as required and participates in committees as directed.
• Uses a flexible approach with a diverse population.
• Works in cooperation with coworkers and supervisory staff.
• Promotes teamwork.
• Communicates effectively with staff and the public.
• Able to use critical thinking to make decisions and problem solve.
• Accepts and uses direction and supervision.
• Travel to SYH and San Diego PACE sites.
• Ability and willingness to self-motivate, prioritize, and be agreeable to change processes to improve effectiveness.
• Interacts in a manner which is professional, respectful, positive, helpful, and promotes trust.
• Performs other related duties as assigned or requested.

Job Requirements:

Education Required (Minimum level of education):

High school diploma or GED equivalent

Certifications/Licenses:

Medical Terminology, CPC or Medical Assistant preferred.

Experience Required (Minimum level of experience):

1 year in medical field to include front and/or back office required
Referral authorization knowledge, and data processing preferred.

1 year of experience with Electronic Medical Record Systems preferred.

Verbal and Written Skills Required to perform the Job:

Bilingual (Spanish/English). Good verbal and written communication skills in both languages.

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, e-FAX, TruChart, Adobe Pro, Microsoft Office

Working Conditions and Physical Requirements:

Prolonged sitting position, walking, constant telephone and email communication. May be required to work evenings and/or weekends.

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 108,000 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 mission-driven team! San Ysidro Health has a long-standing 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 HIV-related 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.