Referrals Specialist (Riverside)
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Salary: $21 - $32 per hour 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.
- 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.
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