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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.
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