Referral Specialist jobs in Irvine, CA

Description

About Us

Our physicians offer a full scope of occupational medicine services designed to help reduce healthcare costs, while minimizing lost work time and increasing employee productivity. To accomplish these goals, Akeso is outcome focused and provides medical care on an urgent or appointment basis for occupational injuries and illnesses. We also design modified work and rehabilitation programs to enable injured employees to return to work as soon as possible.

Job Summary:

As a WC Referral Specialist, you will contribute to the patient experience from start to finish. This role demands multi-tasking in a fast-paced environment. Your role will be to help coordinate medical treatment requests by directing and facilitating specialty referrals between medical providers and partnering medical facilities. This role is pivotal in managing and maneuvering the care of patients with internal and external Specialty Providers, as well as, partnering with Claims Administrators, employer Risk Managers and Applicant Attorneys when needed.

If you have the ability to represent the highest quality of care in all aspects of patient engagement, and a willingness to demonstrate a very caring and respectful demeanor we want to hear from you. The ideal candidate will reflect our mission of offering highly personalized, compassionate care and be excited by the opportunity to learn and grow with the Practice. Candidate should also be able to demonstrate a positive attitude, strong communication, and computer skills.

Essential Duties and Responsibilities: 

• Maneuver patient medical care throughout the continuum from initial appointment to the patient’s release while working closely with Physicians, Case Managers, Claims Administrators and Applicant Attorneys 

• Communicates with Clinic Operations Managers and Employers to obtain claims data such as claim numbers and claims adjuster contact information

• Review specialty Requests for Treatment Authorization (RFA) for completion and submission to claims administrators

• Works closely with Occ Med providers and In-house Specialty providers to coordinate appropriate treatment plans

• Provides feedback and file reviews to Akeso Providers and Clinic staff

• Manage follow-up requests and authorization amendments for specialty care

• Reviews Employer/Claims Administrator MPNs for proper referral coordination

• Communicates with external specialty facilities regarding referral submission

• Coordinate and schedule authorized treatment referrals to internal and external Specialty Providers

• Manage heavy phone calls throughout the day

• Provide status updates to patients and providers as well as claims administrators

• Notifies clinic staff and physicians of determinations received for specialty referrals

• Providing excellent customer service by acting as a liaison for employers, insurers, case managers and Akeso provider

• Assists with new hire training

• Other duties include maintaining patient records; obtaining additional information from physicians as needed; follow-up on delayed/missing determinations

Requirements

• Excellent communication skills and accurate data entry

• Strong written and verbal communication skills

• Detailed oriented with strong organizational and time management skills

• Ability to work alone, take the initiative, and work with little direction

• Must have a strong sense of discretion, urgency, and professionalism

• Should be able to work as part of a team as well as work independently

• Collaboration Skills

• Ethical Conduct

• Thoroughness

• Leadership Mindset

Education, Licenses/Certification:

• At least 3-4 years of work experience in a similar role

• Must have a positive helpful attitude and ability to discuss issues with manager, physicians, and colleagues and relay information in a timely manner

• Possesses knowledge of Workers’ Compensation insurance and medical terminology

• Strong customer service skills

• Must have the ability to build trust with physicians, employers, claims adjusters, and case managers

• Should have knowledge of electronic medical record (EMR) systems and have the ability to keep up in a fast-paced environment

Preferred Qualifications: 

• Knowledge of Medical terminology 

• Experience in CA Workers’ Compensation 

• Bilingual

NOTE:  This job description may not include all the duties assigned to the employee and may be updated and modified by the department supervisor, according to the operations at any given time.

The base salary is determined on the candidate's education, qualifications, and experience, and is subject to change based on various internal and external factors.

 Akeso is an equal opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, national origin, disability, genetic information, pregnancy, or any other protected characteristic as outlined by federal, state, or local laws.