Managed Care Referral Specialist I

The Referral Specialist coordinates, processes and documents medical referrals and prior authorizations for a variety of medical services for clinic patients, as requested electronically by clinic providers. This requires clinical knowledge and understanding of CPT and ICD-9(10) codes to meet the requirements of third-party payers and specialty clinics to ensure minimal delay in securing referral appointments or pre-authorizations. As an integral member of the Health Care Team, the Referral Specialist manages a high volume of referrals and pre-authorizations for multiple Providers and collaborates with other Clinic Referral Specialists, Providers, MA's, Patient Service Representatives and other support staff in multiple clinic locations. This position requires the use of clinical and administrative judgment and initiative to determine best approach for both urgent and non-urgent patient care needs.

Responsibilities:

• Completes all required documentation accurately, in a timely manner, and thoroughly in accordance with department standards; in addition, documentation complies with patients' insurance requirements.
• Meets daily referral modification productivity standards for Referral Specialists, adhering to referral processes and guidelines.
• Per referral guidelines, provide appropriate clinical information to specialist.
• Performs other duties as assigned.
• Prepares and processes all referral and pre-authorization paperwork, including gatherings pertinent information as needed via EHR, from incoming phone/email/fax messages, or from clinical team. Contacts various clinics, facilities, and companies to obtain information to accurately complete referral/pre-authorization requests.

Requirements:

• At least 1 year of experience in ambulatory care setting or similar setting is strongly preferred.
• High school diploma or GED equivalent required.
• Medical Terminology Course required, or able to complete within 90 days of hire.
• Bilingual English/Spanish is required.

Rewards:

• Job type: Regular Full-time
• Competitive Salary with Excellent Benefits
• Retirement Plan with Employer Match
• Paid Time Off, Extended Sick Leave and Paid Holidays
• Medical/Dental/Vision/FSA/Life Insurance
• Employee Discounts and Wellness Programs

The successful candidate will have a demonstrated commitment to community medicine and providing culturally competent care to the medically underserved.