Referral specialist job description

Applicants for all positions must be or become fully vaccinated against Covid-19 if selected for hire. Valid medical or religious exemptions will be considered but serial Covid-19 testing will be required to maintain employment.
Coordinates and schedules patient referrals and follow up appointments.


Essential Functions/Responsibilities/Duties


Manages work queues regarding referral activity on a daily basis to ensure timely processing and/or completion. Assists with patient referrals for additional services needed with internal and external medical facilities. Assists with patient insurance authorization. Assists with appointment setup as needed. Coordinates follow up between referral source and patient. Ensures chart notes and follow up documentation is linked to referral. Provides translated educational materials and directions to patients when necessary. Processes incoming correspondence and responds to calls, emails, and faxes.


Qualifications


Education : High School Diploma or General Education Diploma (GED). Experience : One year's experience working in a medical and/or dental front office setting; with insurance referrals and authorizations preferred. Knowledge/Skills/Abilities Required: Bilingual (English/Spanish) required. Must demonstrate the ability to communicate at level 10 on the language proficiency scale to receive bilingual differential pay. Knowledge of or ability to learn medical terminology required. Ability to prioritize work, handle a variety of tasks simultaneously and complete projects in a fast-paced environment. Excellent communication and interpersonal skills. Strong organizational skills.


About YVFWC


We serve more than 181,000 patients across 25 medical clinics, 14 dental clinics, 10 pharmacies, and 64 program sites in two states. We are Level 3 Certified as a Patient-Centered Medical Home (PCMH). With integrated services including medical, dental, pharmacy, orthodontia, primary care nutritional counseling, autism screening, and primary care behavioral health, YVFWC s patient-centered model of care offers patients the full spectrum of care and shelter assistance, energy assistance, weatherization, HIV and AIDS counseling and testing, home visits, and four mobile medical/dental clinics.


Working at YVFWC


Working in our organization means being the passionate champion for those who have no voice. It means having the opportunity to work with underserved populations and with peers committed to the same work.


At Farm Workers Clinic


We will consistently trust one another to work for the common good. We will foster integrity by demonstrating ethical behavior and insisting on doing what we say we will do. We will demonstrate transparency by being candid and truthful no matter the risk. We will create partnerships to strengthen ourselves and our community. We will fight for just treatment for all individuals. We will let joy in. We have the courage to be an agent of change and refuse anything short of excellence.


Our mission celebrates diversity. We are committed to equal opportunity employment.

You could be the one who changes everything for our 26 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.

Serve as a primary on-site referral/authorization (R/A) point of contact to Military Treatment Facilities (MTF) and Markets. Research and respond appropriately and timely to inquiries from MTF customers. Closely monitor delivery of customer service and support and resolving local R/A problems, issues and concerns. Recommend and implement strategies for resolving issues and improving service quality and timeliness. Process certain referral requests to completion. Educates MTF staff and network providers on submission of Referrals and Authorizations. Maintains database of local network providers on their access to care, preferred providers, and discount rates to leverage when processing.

Process referrals from designated MTFs, ensuring they are assigned to provider able to see beneficiary
Research and respond appropriately and timely to inquiries from MTF/Market

Identify and communicate any trends in referral issues to OIM Management Coordinate with local TRICARE Liaison to address systemic and/or local issues through early identification

Coordinate with local TRICARE Liaison to address systemic and/or local issues through early identification

Maintain knowledge of local network access to care, preferred providers, and discount rates to leverage when processing referrals

Education/Experience: Associate's degree or equivalent experience required. Bachelor's preferred. Minimum of 2 years of experience working in association with, or for, a DoD Managed Care Support Contractor (TRICARE), Medicare/Medicaid Program, Commercial Healthcare Plan or Healthcare Provider/Group. Functional understanding of how any/all of the above healthcare programs work and their coordinator of benefits. Experience in customer relations, referral processing, and/or the TRICARE program preferred. Government Security/Clearance/Citizenship Requirements.

Licensure/Certifications: Requires security clearance, CAC/NAC

Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

**TITLE:** TRICARE Referral Specialist

**LOCATION:** Colorado Springs, Colorado

**REQNUMBER:** 1340819

For over 50 years, Family Health Centers of San Diego (FHCSD) has provided affordable, high-quality health care and supportive services to all San Diegans. With more than 2,500 employees spread throughout more than 50 sites around the county, FHCSD is proud of the diversity of its staff as a reflection of the communities it serves.

The reward of working at FHCSD is more than a paycheck and excellent benefits; it is the impact and contribution to the San Diego community that employees value most. If you are passionate about improving the overall health and livelihood of your community, FHCSD is looking for people like you.
Job Description
*The Referral Specialist II coordinates, processes and documents medical referrals and prior authorizations for a variety of medical services for clinic patients, as requested electronically by clinic providers. 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. The Referral Specialist II serves as a team lead, coaching and mentoring lower level staff and supporting team productivity.

Job 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 Electronic Health Record, 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.

Education/Certifications/Licenses/Registrations
*At least 1 year experience in ambulatory care setting or similar setting is strongly preferred.
*High school diploma or GED equivalent required.
*Medical Terminology Course required.
*Or equivalent combination of education and experience that provides the skills, knowledge and ability to perform the essential job duties, and which meets any required state or federal certification requirements.

Experience/Specialized skills (including Language)
*Ability to maintain good interpersonal interactions with clients and co-workers as a member of a multi-disciplinary community health team with a diverse multi-cultural population.
*Ability to multi-task, be flexible, ensure accuracy, and meet changing priorities in a fast-paced, high-workload environment.
*Advanced knowledge of insurance providers, their portals and their expectations for authorization approval.
*Basic computer literacy.
*Basic organizational skills, attention to detail, time-management skills, and strong motivation to meet deadlines and achieve goals.
*Bilingual in Spanish/English preferred.
*Clinical knowledge of medical terminology, medical procedures, CPT, and ICD-9 (10).
*Intermediate written and verbal communication skills.

Rewards:
Job type: Regular Full TimeCompetitive Salary with Excellent BenefitsRetirement Plan with Employer MatchPaid Time Off, Extended Sick Leave and Paid HolidaysMedical/Dental/Vision/FSA/Life InsuranceEmployee Discounts and Wellness Programs

FHCSD was founded by community activists working towards a common goal: caring, affordable, high-quality medical care for all. We are proud to continue this mission today as we provide accessible services to over 210,000 patients across San Diego County. The successful candidate will have a demonstrated commitment to community medicine and providing culturally competent care to the medically underserved.