• Job Description

  Req#: 7446

  Referrals Specialist (San Ysidro, CA - Onsite)

  4004 Beyer Blvd, San Ysidro, CA 92173, USA Req #7446

  Tuesday, May 7, 2024

  Position Summary:
  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.

  Es sential 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.

  Job Requirements:
  Education Required:
  High School Diploma or GED, or 3 or more years of relevant work experience in lieu of education.
  
  Certifications/Licenses Required:
  Coding and Data Processing or Medical Assistant Certificate a plus.

  Experience and Required Skills:
  

  • 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 a t least 2 years of customer service experience.
  • Basic medical terminology and computer skills. Microsoft Office experience (Word, Excel, Outlook) is a plus.
  • Understanding of electronic medical records systems. Experience with EPIC is a plus.
  • 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.

  Verbal and Written Skills Required to Perform the Job:
  Bilingual (Spanish/English) is required. Excellent verbal and written communication skills. Knowledge of basic medical terminology.

  Equipment Used:
  Computer, phone, and fax machine.

  Working Conditions and Physical Requirements :

  Prolonged sitting, walking, constant telephone communication.

  Universal Requirements:

  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.

  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.

  Other details

  • Pay Type Hourly
  • Min Hiring Rate $25.03
  • Max Hiring Rate $33.22

  Apply Now

• About the company

  The mission of the San Ysidro Health Center (SYHC) is “to improve the health and well-being of our community’s traditionally underserved and culturally diverse people.” SYHC is committed to providing the highest quality, compassionate, easily accessib...

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