Referrals Specialist

A bit about us:

Prestige Hospital System
Placed #1 in both California in a broad assessment of excellence in hospital-based patient care.

Why join us?

Competitive Salary$$
Stellar Benefits (Medical, Dental Vision, Life Insurance)
Flexible Schedule
Job Stability
Career growth
The position offers a competitive salary
If you are passionate, thrive in a fast-paced environment and are ready to take your career to the next level, we would love to hear from you.

Job Details

Job Details

We are seeking a dynamic and experienced Consulting Referrals Specialist to join our team in the healthcare industry. This role is pivotal in coordinating all referrals and follow-up care for PACE participants. The specialist will be responsible for receiving, processing, scheduling, and following up on all medical referral requests, including in-house and outside referrals for diagnostic testing, medical specialists, or other providers.

Responsibilities

• Serve as the main point of contact for providers and clinic staff regarding referrals, authorizations, and appointment scheduling.
• Prepare, process, and complete referrals accurately and in a timely manner, including urgent and stat referrals for assigned PACE location.
• Arrange transportation for participants to medical appointments at Neighborhood and other organizations, including escort coordination.
• Communicate referral details and appointment information/instructions to participants and their families.
• Track referrals in the designated logs and/or electronically via electronic medical records (EMR).
• Follow up on submitted authorization requests and maintain consistent status updates via EMR.
• Monitor and report on statuses of authorization requests; escalate issues as necessary until fully resolved and referral loop is closed.
• Complete surgery scheduling with proper CPT codes and all needed follow-ups, including pre and post order management, labs, EKG, images, etc.
• Manage 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.
• Advocate and discuss with participants all aspects of the referral process as needed or requested by the treating provider.
• Screen and answer related referral calls by telephone, text message, patient portal, and/or by mail.
• Act as a liaison between participant, clinic/providers, specialty care providers, hospitals, and other community resources.

Qualifications

• High school diploma/GED required.
• One year clinical or healthcare experience required.
• Experience with referral authorization and data processing preferred.
• One year experience working with frail and elderly populations preferred.
• Bilingual (English/Spanish) required.
• Excellent verbal and written communication skills, including superior composition, typing and proofreading skills.
• Ability to interpret a variety of instructions in written, oral, diagram, or schedule form.
• Knowledgeable about and experience with current procedural terms (CPT), international classification of diseases (ICD-10), and medical terminology.
• Ability to successfully manage multiple tasks simultaneously.
• Excellent planning and organizational ability.
• Ability to work as part of a team as well as independently.

The ideal candidate must have 5+ years of experience in a similar role. If you have the necessary skills and experience, we encourage you to apply.

Jobot is an Equal Opportunity Employer. We provide an inclusive work environment that celebrates diversity and all qualified candidates receive consideration for employment without regard to race, color, sex, sexual orientation, gender identity, religion, national origin, age (40 and over), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. Jobot also prohibits harassment of applicants or employees based on any of these protected categories. It is Jobot's policy to comply with all applicable federal, state and local laws respecting consideration of unemployment status in making hiring decisions.

Sometimes Jobot is required to perform background checks with your authorization. Jobot will consider qualified candidates with criminal histories in a manner consistent with any applicable federal, state, or local law regarding criminal backgrounds, including but not limited to the Los Angeles Fair Chance Initiative for Hiring and the San Francisco Fair Chance Ordinance.

Information collected and processed as part of your Jobot candidate profile, and any job applications, resumes, or other information you choose to submit is subject to Jobot's Privacy Policy, as well as the Jobot California Worker Privacy Notice and Jobot Notice Regarding Automated Employment Decision Tools which are available at jobot.com/legal.

By applying for this job, you agree to receive calls, AI-generated calls, text messages, or emails from Jobot, and/or its agents and contracted partners. Frequency varies for text messages. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You can reply STOP to cancel and HELP for help. You can access our privacy policy here: jobot.com/privacy-policy