Responsible for timely processing, documenting, and follow up of referrals and request for treatment authorizations as requested by the primary physician and contracted network providers/vendors.
Essential Functions of the Job:
- Receives and processes referrals and approvals in alignment with the minimum expectations of CMS.
- In an expeditious manner, reviews existing PACE network of providers, coordinates and schedules specialty appointments as needed.
- Obtains approvals from providers and disseminates information to participants in writing or electronic media.
- Coordinates care within the guidelines of multiple providers.
- Responds to inquiries as to status of authorizations by assessing the request and evaluating the circumstances to provide the correct information.
- Initiates the appropriate documentation of requests from specialties offices for ongoing care.
- Follows-up on missing documentation on submitted authorization requests to obtain sufficient information.
- Uses various modules of the computer system to obtain information, query information and process orders and authorizations.
- Accurately documents on the various platforms and computer systems to ensure expeditious outcomes to all requested services.
- Communicates effectively with Providers and PACE participants while coordinating referrals and specialty appointments/services.
- Maintains established departmental policies and procedures, objectives quality assurance program, safety and environmental.
- Enhances professional growth and development through participation in educational programs, current literature, in-service meetings and workshops.
- Attends meetings as required and participates in committees as directed.
- Performs other related duties as assigned or requested.
- High school diploma or GED equivalent
- Medical Terminology, CPC, coding, or Medical Assistant
- 2 years’ experience in the medical field, OR
- Bachelor’s degree, OR
- An equivalent combination of education and experience that provides the skills, knowledge, and ability to perform the essential job duties is required.
- 2 years in health plan of clinic setting.
- One year of experience with Electronic Medical Record Systems.
- Excellent verbal and written communication skills.
- Previous experience or strong desire to learn complex computer systems
- Technical proficiency with the Microsoft Office suite of applications.
- Demonstrated ability in resolving problems and communicating solutions verbally and/or in writing to the affected parties.
- Experience identifying and presenting information with tact and skill.
- Demonstrated critical thinking skills, and consistent use of analytical and problem-solving skills.
- Demonstrated ability to be culturally sensitive and respect diversity.
- Detail oriented with strong time management and organizational skills
- Medical terminology and basic computer.
- Typing of 35 wpm.
- Ability to handle multiple activities simultaneously.
- Be attentive to patient needs and concerns.
- Willing to work with others as a team member.
- Personal computer, FAX, e-FAX, TruChart, Epic, QuickCap, Adobe Pro, Microsoft office
- Prolonged sitting position, walking, constant telephone and email communication.
- May be required to work evenings, holidays and/or weekends.
Pre employment requirements include I-9, physical, positive background and reference check results, complete application, new hire orientation, pre-employment PPDs.
About Us San Ysidro Health is a Federally Qualified Health Care organization committed to providing high quality, compassionate, accessible and affordable healthcare services for the entire family. The organization was founded by seven women in search of medical services for their families and community. Almost 50 years later, San Ysidro Health now provides innovative care to over 108,000 patients through a vast and integrated network of 47 program sites across the county. San Ysidro Health could not serve our patients without the dedication of our passionate and hardworking employees. Apply today and become a part of our mission-driven team! San Ysidro Health has a long-standing commitment to equal employment opportunity for all applicants for employment. Employment decisions including, but not limited to, those such as employee selection, performance evaluation, administration of benefits, working conditions, employee programs, transfers, position changes, training, disciplinary action, compensation, and separations are made without regard to race, color, religion (including religious dress and grooming), creed, national origin, nationality, citizenship status, domestic partnership status, ancestry, gender, affectional or sexual orientation, gender identity or expression, marital status, civil union status, family status, age, mental or physical disability (including AIDS or HIV-related status), atypical heredity cellular or blood trait of an individual, genetic information or refusal to submit to a genetic test or make available the results of a genetic test, military status, veteran status, or any other characteristic protected by applicable federal, state, or local laws.
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