medical referral coordinator

Nelson Dermatology

About the PositionWe are seeking an energetic, hard working Referral Coordinator/Medical Receptionist Specialist needed to join our busy, growing dermatology practice . Excellent Pay and Benefits provided. Work hours Monday through Friday 8AM-5PM. No nights or weekends.The successful candidate will be responsible for coordinating and verifying referrals into our office from PCPs, managing medication prior authorizations, verifying insurance coverage, and providing general administrative support. The ideal candidate should have previous experience with referrals (including online verification) and prior authorization processes, excellent customer service skills, a professional demeanor, and the ability to multi-task in a fast-paced environment. Previous experience as receptionist/front desk specialist in a medical office is required.Responsibilities:<ul><li>Verify patients insurance status and need for referrals from PCPs through online databases</li><li>Request, coordinate and confirm all in-coming referrals from PCP offices</li><li>Complete medication prior authorization forms and coordinate their approval with insurances and patients</li><li>Greet patients and visitors in a professional manner.</li><li>Schedule appointments and answer phone calls.</li><li>Update patient information in the electronic medical record system.</li><li>Assist with administrative tasks such as filing, faxing, and copying documents.</li></ul>About usNelson Dermatology is a private dermatology practice with locations in Saint Petersburg, FL and St. Pete Beach, FL. We are a comprehensive dermatology practice that prides itself on being professional, fast-paced, and focused on providing the best comprehensive care to our patients.Our work environment includes:<ul><li>Modern office settings</li><li>Company perks</li><li>Lively atmosphere</li></ul>We look forward to welcoming the newest member to our team.Job Type: Full-timePay: From $17.00 per hourBenefits:<ul><li>401(k)</li><li>401(k) matching</li><li>Disability insurance</li><li>Health insurance</li><li>On-the-job training</li><li>Opportunities for advancement</li><li>Paid sick time</li><li>Paid time off</li><li>Uniform allowance</li></ul>Experience:<ul><li>Medical receptionist: 1 year (Preferred)</li><li>EMR systems: 1 year (Preferred)</li></ul>Ability to Commute:<ul><li>Saint Petersburg, FL 33701 (Required)</li></ul>Work Location: In person

Medical Receptionist/Referral Coordinator

Portneuf Medical Center

<div>Overview:
<div>
Join our team as a day shift, full-time, Referral Operations Referral Program Coordinator in Portneuf, ID.</div><div></div><div> 
Why Join Us?</div><div></div><div> 
Thrive in a People-First Environment and Make Healthcare Better</div><ul><li>
Thrive: We empower our team with career growth opportunities, tuition assistance, and resources that support your wellness, education, and financial well-being.</li><li>
People-First: We prioritize your well-being with paid time off, comprehensive health benefits, and a supportive, inclusive culture where you are valued and cared for.</li><li>
Make Healthcare Better: We use advanced technology to support our team and enhance patient care.</li></ul>
Get to Know Your Team:<ul><li>
Ardent Health is a leading provider of healthcare in growing mid-sized urban communities across the U.S. With a focus on people and investments in innovative services and technologies, Ardent is passionate about making healthcare better and easier to access. Through its subsidiaries, Ardent delivers care through a system of 30 acute care hospitals, 24,000+ team members, and more than 280 sites of care with over 1,800 affiliated providers across six states.</li></ul>
Responsibilities:
<ul><li>This position is responsible for processing internal, incoming, and external referrals for Ambulatory services, procedures, and medications.
</li><li>The Referral Coordinator will obtain prior authorizations, schedule patients, work inbound and outbound phone calls, and communicate with patients via online chat.
</li><li>Will consider highly qualified applicants for hybrid or remote positions.</li></ul>
Qualifications:
<div>
Job Requirements</div><ul><li>
Minimum: High School Diploma; GED.</li><li>
Ability to produce in an autonomous work environment; consistently at work and on time, as established; arrives at meetings and appointments on time.</li><li>
Excellent communication skills &ndash; Speaks clearly and persuasively in positive or negative situations; listens well and asks and answers questions; selects and uses appropriate communication methods.</li><li>
Provides excellent customer service &ndash; Manages difficult situations and responds promptly and completely.</li><li>
Identifies and resolves problems on time.</li><li>
Excellent time management &ndash; Prioritizes and completes assigned work.</li><li>
Excellent teammate &ndash; Provides and welcomes feedback, establishes and maintains effective professional relationships, works cooperatively, and offers professional assistance and support to co-workers.</li><li>
Two or more years of experience with Electronic Health Record (EHR).</li></ul><div>
Preferred Job Requirements</div><ul><li>
Certified Medical Assistant.</li></ul></div><div></div>

Referral Program Coordinator

ECU Health

<div>
 Position Summary
 
 
 The Referral Coordinator must demonstrate the knowledge and skills necessary to coordinate operations of the referral processes, including, but not limited to pre-certifications, and scheduling appointments. Coordinate operations and processes of the Centralized Referral Office. Office equipment operation and additional duties as required by practice manager.
 
 
 
 Minimum Requirements
 
 
 
 High School or higher plus 1-2 years formal training/education is required.
 
 
 Must possess CPT and ICD-9/10 coding knowledge. Must know medical terminology, anatomy and physiology.
 
 
 1-3 years related work experience.
 
 
 
 Must Possess Computer Skills, With Excel And Word Knowledge/experience
 
 
 
 Medical Office experience is preferred.
 
 
 Other Information
 
 
 Standard schedule is Monday through Friday, 8:00 AM to 5:00 PM.
 
 
 Please note that special projects, operational needs, or departmental support may occasionally require earlier start times or extended hours beyond the standard schedule.
 
 
 ECU Health
 
 
 
 About ECU Health Medical Center
 
 
 
 ECU Health Medical Center, one of four academic medical centers in North Carolina, is the 974-bed flagship hospital for ECU Health and serves as the primary teaching hospital for The Brody School of Medicine at East Carolina University. ECU Health Medical Center has achieved Magnet&reg; designation twice and provides acute and intermediate care, rehabilitation and outpatient health services to a 29-county region that is home to more than 1.4 million people.
 
 
 General Statement
 
 
 It is the goal of ECU Health and its entities to employ the most qualified individual who best matches the requirements for the vacant position.
 
 
 Offers of employment are subject to successful completion of all pre-employment screenings, which may include an occupational health screening, criminal record check, education, reference, and licensure verification.
 
 
 We value diversity and are proud to be an equal opportunity employer. Decisions of employment are made based on business needs, job requirements and applicant&rsquo;s qualifications without regard to race, color, religion, gender, national origin, disability status, protected veteran status, genetic information and testing, family and medical leave, sexual orientation, gender identity or expression or any other status protected by law. We prohibit retaliation against individuals who bring forth any complaint, orally or in writing, to the employer, or against any individuals who assist or participate in the investigation of any complaint.
</div>

Referral Coordinator - ECU Peds General Peds Clinic

TRISTAR

<div>POSITION SUMMARY:
Work directly with the Supervisor and Manager to provide additional resources for the case management staff. This position does not provide any clinical review or decisions.
This individual is responsible for monitoring incoming correspondence received. The coordinator will ensure the referrals are set up in the case management system and promptly assigned to the case manager. The Referral Coordinator will answer incoming calls, screen, respond and route the calls. This position requires the ability to work independently to meet deadlines, as well as an excellent phone demeanor and a desire to provide exceptional customer service. The position requires knowledge of medical terminology, the understanding of referral criteria by client and/or jurisdictions. The referrals may be for WC Utilization Review and or Case Management services.
Responsibilities of the position include, but are not limited to:<ul><li>
Set up of member within the case management system</li><li>
Assist incoming calls to the case management referral department
</li><li>Monitor dedicated referral emails to review for new referrals and correspondence</li></ul><ul><li>
Monitor workflow of referrals and identify areas where daily assistance is needed</li><li>
Work with the branch locations and staff to complete and provide necessary information for referrals
</li><li>Process all referrals and correspondence within 24 hours of receipt</li><li>
Maintain daily/monthly referral logs
</li><li>Identify trends and/or issues in referral patterns and communicate them with management.</li></ul>
***Other duties as assigned
Additional Functions and Responsibilities
<ul><li>Demonstrates ability to meet administrative requirements, including productivity, time management and Quality Assurance standards
</li><li>Maintain documentation standards adhering to URAC standards and company policy and procedures</li><li>
Maintain confidentiality- Knowledge of laws and regulations pertaining to HIPPA and PHI</li><li>
Other job duties as assigned
</li></ul>Education: High school diploma required. Medical or Managed Care background preferred and/ or Certified Medical Assistant
Experience: Experience in healthcare and or managed care related fields, Minimum of one year of working in a medical or managed care environment preferred. Medical Terminology preferred.
Knowledge, Skills and Abilities:
<ul><li>Experience in healthcare related fields</li><li>
Strong communication skills; customer service mindset; team player.</li><li>
Adheres to professional standards, codes of ethics, system and department policies and procedures.
</li><li>Incorporates the philosophies of continuous quality improvement, customer service and teamwork into daily routine</li><li>
Excellent typing and keyboard skills (35-40wpm)</li><li>
Ability to work in a variety of computer systems proficiently</li><li>
Ability to navigate a Windows environment, utilize Outlook, and the ability to create, edit, save and send documents utilizing Microsoft Word and Microsoft Excel</li><li>
Ability to work within a paperless environment</li></ul>
Equipment Operated/Used:
Essential Equipment: Desk, Telephone/Fax, Computer Keyboard, Mouse, System Applications
Essential Tools: Pens, pencil, computer, Keyboard
Essential Vehicles: N/A
Special Equipment or Clothing:
Professional attire adhering to the Company Dress Code
Here is some benefits that you can enjoy in this role:<ul><li>
Medical, Dental &amp; Vision Insurance</li><li>
Life &amp; Disability Insurance</li><li>
401(k) Plan</li><li>
Paid time off</li><li>
Paid holiday</li></ul>
<div><div>MENTAL AND PHYSICAL REQUIREMENTS</div><div><div> 
1. MENTAL EFFORT
a. Reasoning development:
Follow one- or two-step instructions; routine, repetitive task.
Carry out detail but uninvolved written or verbal instructions; deal with a few concrete variables.
Follow written, verbal, or diagrammatic instructions; several concrete variables.
X Solve practical problems; variety of variables with limited standardization; interpret instructions.
Logical or scientific thinking to solve problems; several abstract and concrete variables.
Wide range of intellectual and practical problems; comprehend most obscure concepts.</div></div><div><div> 
b. Mathematical development:
Simple additional and subtraction; copying figures, counting, and recording.
Add, subtract, multiply, and divide whole numbers.
X Arithmetic calculations involving fractions, decimals, and percentages.
Arithmetic, algebraic, and geometric calculations.
Advanced mathematical and statistical techniques such as calculus, factor analysis, and probability determination.
Highly complex mathematical and statistical techniques such as calculus, factor analysis, and probability determination; require theoretical application.</div></div><div><div> 
c. Language development:
Ability to understand and follow verbal or demonstrated instructions; write identifying information; request supplies verbally or in writing.
Ability to file, post, and mail materials; copy data from one record to another; interview to obtain basic information such as age, occupation, and number of children; guide people and provide basic direction.
Ability to transcribe dictation; make appointments and process mail; write form letters or routine correspondence; interpret written work instructions; interview job applicants.
X Ability to compose original correspondence, follow technical manuals, and have increased contact with people.
Ability to report, write, or edit articles for publication; prepare deeds, contracts or leases, prepare and deliver lectures; interview, counsel, or advise people; evaluate technical data.</div></div><div><div> 
2. PHYSICAL EFFORT
a. Physical activity required to perform the job:
Sedentary work: Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.
X Light work:
a. Exerting up to 20 pounds of force occasionally
b. Exerting up to 10 pounds frequently
c. Exerting a negligible amount of force constantly to move objects
(If the use of arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most of the time, the job is rated for Light Work).
Medium work:
a. Exerting up to 50 pounds of force occasionally
b. Exerting up to 20 pounds of force frequently
c. Exerting up to 10 pounds of force constantly to move objects
Heavy work:
a. Exerting up to 100 pounds of force occasionally
b. Exerting up to 50 pounds of force frequently
c. Exerting up to 20 pounds of force constantly to move objects
Very heavy work:
a. Exerting in excess of 100 pounds of force occasionally
b. Exerting in excess of 50 pounds of force constantly to move objects
c. Exerting in excess of 20 pounds of force constantly to move objects 
</div></div> 
<div><div><ul><li>Visual requirements necessary to perform the job:</li></ul>
Far vision: clarity of vision at 20 feet or more
X Near vision: clarity of vision at 20 inches or less
X Mid-range vision: clarity of vision at distances of more than 20 inches and less than 20 feet
Depth perception: the ability to judge distance and space relationships, so as to see objects where and as they actually are
Color vision: ability to identify and distinguish colors
Field of vision: ability to observe an area up or down or to the right or left while eyes are fixed on a given point
</div></div> 
</div><div><div>2. PHYSICAL EFFORT (cont.) 
FREQUENCY</div><div><div> 
c. Physical activity necessary to perform the job and frequency (e.g., continually, frequently, or occasionally):
Climbing: Ascending or descending ladders, stairs, scaffolding, ramps, poles, and the like, using feet and legs and/or hands and arms. Body agility is emphasized. This factor is important if the amount and kind of climbing required exceeds that required for ordinary locomotion.
Balancing: Maintaining body equilibrium to prevent falling when walking, standing, or crouching on narrow, slippery, or erratically moving surfaces. This factor is important if the amount and kind of balancing exceeds that needed for ordinary locomotion and maintenance of body equilibrium.
Stooping: Bending body downward and forward by bending spine at the waist. This factor is important if it occurs to a considerable degree and requires full use of the lower extremities and back muscles.
Kneeling: Bending legs at knee to come to a rest on knee or knees.
Crouching: Bending the body downward and forward by bending legs and spine.
Crawling: Moving about on hands and knees or hands and feet.
Reaching: Extending hand(s) and arm(s) in any direction.
Standing: Particularly for sustained periods of time.
Walking: Moving about on foot to accomplish tasks, particularly for long distances.
Pushing: Using upper extremities top press against something with steady force in order to thrust forward, downward, or outward.
Pulling: Using upper extremities to extent force in order to drag, haul, or tug objects in a sustained motion.
Foot
Motion: Using feet to push pedals.
Lifting: Raising objects from a lower to a higher position or moving objects horizontally from position to position. This factor is important if it occurs to a considerable degree and requires substantial use of the upper extremities and back muscles.
X Fingering: Picking, pinching, typing, or otherwise working with fingers rather than with the whole hand or arm as in handling.
X Grasping: Applying pressure to an object with the fingers and palm. 
</div><div>Frequently
Occasionally
</div></div> 
</div><div><div>2. PHYSICAL EFFORT (cont.) 
FREQUENCY</div><div><div> 
X Talking: Expressing or exchanging ideas by means of the spoken word. Those activities in which workers must convey detailed or important spoken instructions to other workers accurately, loudly, or quickly.
X Hearing: Perceiving the nature of sounds with or without correction. Ability to receive detailed information through verbal communication and to make fine discriminations in sound, such as when making find adjustments on machined parts.
Feeling: Perceiving attributes of objects, such as size, shape, temperature, or texture by touching with skin, particularly that of fingertips.
X Repetitive Substantial movements (motions) of the wrists, hands,
Motion: and/or fingers.</div><div> 
Regularly
Regularly
Frequently</div></div></div></div>

Case Management Assistant - Referrals

Ballad Health

<div>Job Description: 
Summary: 
The Referral/Pre-Certification Coordinator Verifies and updates patient registration information in Epic. Obtains benefit verification and necessary authorizations (referrals, precertification) prior to patient arrival for all ambulatory visits, procedures, injections, and radiology services. Act as liaison between health plan and physician and/or clinic staff regarding patient complaints and patient non-compliance. Effectively communicate, collaborate, and interact with patients\plan members, multiple levels of internal personnel and external customers. Use complete knowledge of various insurances and stays current on constantly changing requirements, contracted plans, and any other pertinent information pertaining to referrals. Utilize online, web-based verification systems and reviews real-time eligibility responses to ensure accuracy of insurance eligibility. Create appropriate referrals to attach to pending visits. Verify patient demographic information and insurance eligibility including coordination of benefits; update and confirm as necessary to allow processing of claims to insurance plans. Complete chart prepping tasks daily to ensure smooth check-in process for the patient and clinic. Research all information needed to complete registration process, obtaining information from clinicians, ancillary services, and patients. As needed, fax referral/authorization form(s) to PCPs and insurance companies in a timely manner. Review and notify front office staff of outstanding patient balances. Maintain satisfactory productivity rates and ensure the timeliness of claims reimbursement while maintaining work queue goals. Responsible for handling the collection and documentation of patient referrals from BHMA physicians for specialist care to obtain the necessary approval, preauthorization, precept, or referral from the managed care companies or other parties requiring authorization. 
Respond to In-house clinician and support staff questions, requests, and concerns regarding the status of patient referrals, care coordination or follow-up status. Identify and communicate trends and/or potential issues to management team. Index referrals to patient accounts for existing patients. Create new patient accounts for non-established patients to index referrals. 
Various duties as they arise. 
Requirements: 
Education/Experience: 
Required &ndash; High School Graduate and 2 years' prior experience in the medical field. 
Knowledge/Skills Abilities: 
Excellent phone etiquette - verbal, written and listening skills. Must have strong customer service skills, demonstrating tact and sensitivity in stressful situations. Knowledge of medical terminology and CPT, HCPCS and ICD coding. Prior experience utilizing electronic medical records. Ability to maintain confidentiality and observe HIPAA compliance. Be able to process 60-80 referrals daily. 
Preferred: 
Associates Degree or bachelor's degree in Healthcare or Business-related field. 
 
 
Work Requirements: 
Shift: Day 
On Call: No 
Weekends: No 
Travel Required: No Travel 
Shift Details: 8a-430p
 
City/State: Abingdon, VA
Location: 
Ballad Health Medical Associates</div>

Referral/Pre-Certification Coordinator (8a-430p) - Abingdon, VA

Paradigm Corp

Paradigm is an accountable specialty care management organization focused on improving the lives of people with complex injuries and diagnoses. The company has been a pioneer in value-based care since 1991 and has an exceptional track record of generating the very best outcomes for patients, payers, and providers. Deep clinical expertise is the foundation for every part of Paradigm’s business: risk-based clinical solutions, case management, specialty networks, home health, shared decision support, and payment integrity programs.
 We’re proud to be recognized—again! For the fourth year in a row, we’ve been certified by Great Place to Work®, and for the third consecutive year, we’ve earned a spot on Fortune's Best Workplaces in Health Care™ list. These honors reflect our unwavering commitment to fostering a positive, inclusive, and employee-centric culture where people thrive.
 Watch this short video for a brief introduction to Paradigm.
 
We are seeking a full-time, fully remote Orthotics DME Referral Care Coordinator to support a fast-paced, high-volume referral coordination department focused on DME orthotics and bracing (e.g., knee braces, ankle-foot orthoses/AFOs, wrist/hand braces, cervical collars, lumbar supports/LSOs, thoracic-lumbar-sacral orthoses/TLSOs). In this role, you’ll partner closely with referral sources, injured workers/patients, and orthotics/bracing providers to ensure timely authorization, ordering, status updates, and delivery confirmation—while maintaining accuracy, excellent customer service, and compliance. Candidates must have hands-on experience specific to DME orthotics and bracing and be comfortable managing multiple priorities in a production-driven environment. Schedule is Monday–Friday, 9:30 a.m.–6:00 p.m. Eastern Time.
 
Responsibilities: 
<ul>
<li>Receive DME referrals, communicate status and receipt of DME to referral sources. Ensure written authorization from payor source prior to delivery of equipment. Provide updates to referral sources, provider, and injured worker as well as confirmation of DME delivery. Work closely with referral sources, injured workers and DME providers to ensure appropriate DME is delivered in a specified timeframe. Follow up with injured workers and referral sources in a timely manner to ensure customer satisfaction.</li>
<li>Provide accurate, timely pricing to the Billing Department to ensure DME billing is accurate. Expand current list of DME providers, mindful to secure best possible pricing for equipment.</li>
<li>Coordinate specific work tasks with internal teams as needed to ensure smooth and efficient flow of information. Responsive to inquiries within given timeframes and within established policy. Appropriately follow up with supervisor, co-workers or residents regarding reported complaints, problems, and concerns.</li>
<li>Positively support the mission, values, and vision of Paradigm Corp. through effective communication with internal and external customers, serve as positive role model, demonstrate excellent customer service, and comply with all applicable regulatory requirements and Quality Assurance initiatives, including providing a work environment free from all illegal and discriminatory behavior and harassment, including sexual harassment.</li>
<li>Duties may include taking call on weekends, for which compensation will be provided.</li>
<li>Maintain reliable and predictable attendance during scheduled work hours.</li>
</ul>
Qualifications: 
<ul>
<li>Education/Training: Some college credit and/or experience in a related discipline.</li>
<li>Experience: At least one (1) year of related experience (e.g., healthcare, DME, insurance, physician practice).</li>
<li>Skills: Excellent communication skills, verbal and written; Proficient in reading, grammar, and mathematics. Strong computer skills (e.g., Outlook, Excel, Word, Teams, proprietary software for which training will be provided); Accuracy and efficiency required. Excellent organizational, prioritization and multi-tasking skills. Knowledgeable of medical terminology.</li>
<li>Maintain Confidentiality of all data, including ensuring protection injured workers’ rights, Protected Health Information (PHI), employee, and operations data.</li>
<li>Compliance with all regulatory requirements, current laws and policies which protect workers from harassment and all illegal and discriminatory behavior. Comply with applicable Quality Assurance initiatives.</li>
<li>Complete requirements for required training, demonstrate acceptable attendance, and appropriate personal appearance.</li>
<li>Cooperate and work well together with all co-workers, ensuring all communication is professional and cordial; Plan, execute and complete job duties with minimal supervisory direction, utilizing appropriate sound judgment.</li>
<li>Equipment/Machinery Used: Standard office equipment including phones, calculators, copiers, scanners, fax, laptop/PC, copiers, various computer programs, mailing equipment, etc.</li>
</ul>
Paradigm Benefits: 
<ul>
<li>Health and wellness– We want our people to be and stay healthy, so we offer PPO, HDHP, and HMO health insurance options with Cigna and Kaiser (CA employees only).</li>
<li>Financial incentives – Paradigm’s financial benefits help prepare you for the future: competitive salaries, 401(k) matching contributions, employer-paid life and disability insurance, flexible spending and commuter accounts, and employer-matched HSA contributions.</li>
<li>Vacation - We believe strongly that work-life balance is good for you and for our company. Our paid time off and personal holiday programs give you the flexibility you need to live your life to the fullest.</li>
<li>Volunteer time– We want our employees to engage with and give back to their communities in meaningful ways. Full and part-time employees receive one paid day per calendar year.</li>
<li>Learning and development: One of Paradigm’s core values is expertise, so we encourage our employees to continually learn and grow. We support this in a variety of ways, including our new Learning Excellence at Paradigm (LEAP) program.</li>
</ul>
Paradigm believes that fostering a diverse and inclusive workplace is central to our mission of helping more people and transforming lives. We’re striving to build a culture that better reflects the society we live in and empowers our team to deliver the highest levels of compassion and care to those we serve. For us, achieving this goal requires a workforce that respectfully embraces differences and commits to positive change, creating an environment where everyone is able to bring their whole self to work.
 
Paradigm complies with federal and state disability laws and makes reasonable accommodations for applicants and employees with disabilities. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact Leave Management at leave.management@paradigmcorp.com.
 
We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.
 
As a contractor with the State of Wisconsin, Paradigm complies with Wisconsin Contract Compliance Law (§16.765). Poster link: Contract Compliance Law Poster
 
#LI-Remote

Orthotics DME Referral Care Coordinator

Neighborhood Healthcare

<div>Community health is about more than just vaccines and checkups. It&rsquo;s about giving people the resources they need to live their best lives. At Neighborhood, this is our vision. A community where everyone is healthy and happy. We&rsquo;re with you every step of the way, with the care you need for each of life&rsquo;s chapters. At Neighborhood, we are Better Together.

Neighborhood Healthcare PACE is a managed medical plan built around surrounding participants with a team of physicians, nurses, social workers, therapists and care coordinators to help them maintain good health and a good quality of life. Our goal is to keep our seniors happy and healthy at home surrounded by their family and community.

As a private, non-profit 501(C) (3) community health organization, we serve over 500k medical, dental, and behavioral health visits from more than 100,000 people annually. With two PACE centers located in Riverside County, our PACE program is positioned to serve over 650 senior participants.

The Referrals Specialist will coordinate all referrals and follow-up care for PACE participants. The specialist is also 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.

Schedule: Monday-Friday, 7:30am-4:00pm.

Responsibilities

Direct Patient Care
<ul>
<li>Serves as the main point of contact for providers and clinic staff regarding referrals, authorizations, and appointment scheduling</li>
<li>Prepares, processes, and completes referrals accurately and in a timely manner, including urgent and stat referrals for assigned PACE location</li>
<li>Arranges transportation for participants to medical appointments at Neighborhood and other organizations, including escort coordination</li>
<li>Communicates referral details and appointment information/instructions to participants and their families</li>
<li>Tracks referrals in the designated logs and/or electronically via electronic medical records (EMR)</li>
<li>Follows up on submitted authorization requests and maintains consistent status updates via EMR</li>
<li>Monitors and reports on statuses of authorization requests; escalates issues as necessary until fully resolved and referral loop is closed</li>
<li>Completes surgery scheduling with proper CPT codes and all needed follow ups, including pre and post order management, labs, EKG, images, etc.</li>
<li>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</li>
<li>Reviews consultation reports for needed follow up requests and works with providers to ensure timely processing of all follow ups</li>
<li>Works with the health information department to ensure timely retrieval of consultation reports</li>
<li>Reschedules missed appointments and notifies the provider according to no show policies</li>
<li>Arranges the retrieval of CD images and provides to medical specialist to ensure appointment are kept and completed</li>
<li>Submits retro-authorizations and distinguishes between primary care and internal specialty visits</li>
<li>Documents all actions taken in the participant medical record in accordance with current Clinic, DHCS and CMS regulations/guidelines</li>
<li>Advocates and discusses with participants all aspects of the referral process as needed or requested by the treating provider</li>
<li>Screens and answers related referral calls by telephone, text message, patient portal, and/or by mail</li>
<li>Acts as a liaison between participant, clinic/providers, specialty care providers, hospitals, and other community resources</li>
</ul>
Provider &amp; Team Support
<ul>
<li>Obtains referrals and authorizations from providers in timely manner</li>
<li>Communicates referrals and authorizations information and pertinent medical information to the specialty provider</li>
<li>Participates in scheduled department meetings</li>
<li>Shares accountability for overall participant health outcomes, working in coordination with care teams</li>
</ul>
Customer Relations
<ul>
<li>Maintains a professional working relationship with all levels of staff, clients, and the public</li>
<li>Cooperates, as part of a team, in accomplishing department goals and objectives</li>
<li>Maintains positive relationships with all participants, prospective participants, clinical staff, prospective employees, fellow co-workers and referral sources</li>
</ul>
Qualifications

Education/Experience
<ul>
<li>High school diploma/GED required</li>
<li>One year of clinical or healthcare experience required</li>
<li>Experience with referral authorization and data processing preferred</li>
<li>One year of experience working with elderly populations preferred</li>
<li>Bilingual (English/Spanish) highly preferred</li>
<li>Current Basic Life Support (BLS) certification is required upon hire and must be maintained as a condition of employment. These courses must follow AHA guidelines, but may be completed through approved online providers such as ProMed or other equivalent programs that meet recognized BLS standards</li>
</ul>
Additional Qualifications (Knowledge, Skills and Abilities)
<ul>
<li>Excellent verbal and written communication skills, including superior composition, typing and proofreading skills</li>
<li>Ability to interpret a variety of instructions in written, oral, diagram, or schedule form</li>
<li>Knowledgeable about and experience with current procedural terms (CPT), international classification of diseases (ICD-10), and medical terminology</li>
<li>Ability to successfully manage multiple tasks simultaneously</li>
<li>Excellent planning and organizational ability</li>
<li>Ability to work as part of a team as well as independently</li>
<li>Ability to work with highly confidential information in a professional and ethical manner</li>
</ul>
Physical Requirements
<ul>
<li>Ability to lift/carry 10 lbs/weight</li>
<li>Ability to stand for long periods of time</li>
</ul>
Neighborhood Healthcare offers a generous benefit plan that includes: 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, and much more!

Pay range: $22.80-$32.04 per hour, depending on experience.

Compensation Disclosure: The posted salary range reflects the designated pay grade for this position. While this range represents the broader classification of the role, actual compensation will be based on several factors, including but not limited to: the candidate&rsquo;s overall knowledge, skills, and experience, market data and industry benchmarks, internal equity within the organization, Budgetary considerations and organizational needs. As a result, placement within the range is not guaranteed, and the full pay grade range may not be utilized.</div>

Referrals Specialist-PACE

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