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Referral Specialist I

Company: Family Health Centers of San Diego
Location: Imperial Beach
Posted on: November 26, 2022

Job Description:

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.General Job Description *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.Job Roles *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.Education/Certifications/Licenses/Registrations *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.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.*Basic computer literacy (i.e., use system to manage and schedule appointments, access electronic medical record information).*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 knowledge of insurance providers, their portals and their expectations for authorization approval.*Intermediate written and verbal communication skills, including ability to communicate effectively with patients and family members who speak English as a second language.

Keywords: Family Health Centers of San Diego, San Diego , Referral Specialist I, Other , Imperial Beach, California

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