PACE Referrals Specialist

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.
• 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.
• Follows-up on missing documentation on submitted authorization requests to obtain sufficient information for request to be reviewed by UM.
• Uses various modules of the computer system to obtain information, query information and process authorizations.

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. 
• 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 or Medical Assistant

Experience Required (Minimum level of experience):

• 2 years in medical field to include front and/or back office, referral - authorization knowledge, and data processing.
• 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:

• Preferred: Bilingual (Arabic/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, EPIC, 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.

Universal Requirements

Pre employment requirements include I-9, physical, positive background and reference check results, complete application, new hire orientation, pre-employment 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 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.