Referral Specialist jobs in Santa Cruz, CA

Description

Salud Para La Gente (SALUD) provides high quality, comprehensive and cost-effective healthcare to underserved low-income communities in the Monterey Bay area, including Santa Cruz County and North Monterey County. We began in Watsonville 1978 as a storefront “free clinic,” and with the ever growing need for health services, in 1992 became a federally qualified health center (FQHC). Today we are a primary health care network with 11 clinic sites, over 400 employees, and continue to provide high quality services to patients of all ages.

SALUD offers a competitive salary and benefits package and a collaborative culture that values excellence, achievement, innovation and compassion.   

We are seeking an experienced, organized and detail-oriented Referral Specialist to coordinate patients’ access to specialty care providers and services.  

Responsibilities include, but are not limited to, the following:

1. Follow Doctor’s order as noted and follow through in a timely, effective manner.
2. Coordinate and process the STAT/URGENT referrals to be completed within 24 hours for patients with critical health care needs.
3. Coordinate and process the Routine Referrals in 5 business days.
4. Monitor and follow up on EHR referral queue and ensure timely closing of open orders in a 30, 60, 90 days review system.
5. Notify patients of their appointments, the location and special test preparations outside the clinic, provide follow-up instructions as needed.
6. Verify eligibility by obtaining a RAF, TAR or other documentation.
7. Ensure complete and accurate registration, including patient demographic and current insurance information.
8.  Assemble information concerning patient’s clinical background and referral needs. Per referral guidelines, provide appropriate clinical information to specialist.
9. Maintain ongoing tracking and appropriate documentation on referrals to promote team awareness and ensure patient safety. This tracking may be used in the EHR system by using Task and notes in appropriate fields.
10. Contact review organizations and insurance companies to ensure prior approval requirements are met. Present necessary medical information such as history, diagnosis and prognosis. Provide specific medical information to financial services to maximize reimbursement to the hospital and physicians.
11. Review details and expectations about the referral with patients.
12. Respond to patient’s inquiries in a timely manner in relation to their referrals.
13. Train staff, as needed, on new referral systems.
14. Insurance Liaison – Verify eligibility, pending authorizations and follow up as needed; identifies additional sources of assistance for uninsured and/or underinsured families.
15. Assist pediatric and adult providers in coordination of all hospital admissions details.
16. Organize pediatric and adult referral scheduling and prepare paperwork/records in anticipation of provider needs.
17. Liaison between patients, providers, outside clinics, and hospitals regarding scheduling and follow-up for emergent and short-term cases. 
18. Schedule transportation for eligible members as needed.
19. Communicate information via computer, phone, fax, and in writing to appropriate resources.

20. Reprioritize work on a continuous basis accommodating changes.

21. Establish, update, and maintain a computer based tracking system for all referrals.

22. Use computer to enter data or to retrieve information as required. Generate reports as needed.

23. If time allows, assist with assignments and cover for other staff members in their absence.

24. Maintain an effective working relationship with staff, managers, providers and the community.

25. Perform other duties as assigned.

26. Able to work in a high stress environment with individuals of diverse cultural background.  

27. Conduct all activities in a polite, courteous and professional manner and abides by company policies and procedures.

The ideal candidate will embrace our mission to provide high quality health care to patients of all ages, possess excellent communication and problem solving skills, and be familiar with medical terminology and community health care resources.  

Requirements

MINIMUM QUALIFICATIONS

• High school graduate
• 2-3 years of Referrals processing in a healthcare environment. 
• Completed/passed Medical Terminology Course
• School knowledge of ICD-10.
• Bilingual English/Spanish required.
• Basic computer knowledge required (MS Word, Excel, Outlook and Electronic Health Records)
• Excellent oral and written communication skills

***Individuals hired on or after March, 2018, who have not successfully taken a Medical Terminology class (to be confirmed by proof of taking and passing class with a grade of “C” or better) will have nine (9) months to successfully complete the class with a grade of “C” or better and they can use the Education Career Development money to pay for the class.**

SALARY & BENEFITS

Salary Range: $20.70 to $25.16 per hour; 

Benefits: Medical, Dental, Vision and Life Insurances, Voluntary Long Term Disability, 401(k) with match, PTO and Holiday Pay

PHYSICAL DEMANDS:

• Standing, walking, sitting, typing reaching, bending, moving and/or lifting up to 50 pounds

Salud is an affirmative action and equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity, national origin, veteran status, or genetic information. Salud is committed to providing access, equal opportunity and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities. To request reasonable accommodation, contact the Salud Human Resources Department, [831-728-8250, and HRDept@splg.org].