Referrals Specialist
1 month ago
Supervisory Responsibilities: This position has no supervisory responsibilities.
General Requirements: All duties performed will be done accurately and in a timely manner.
- Assumes responsibility for maintaining clinical competencies according to Gonzaba Medical Group policy.
- Ensures customer service is always maintained at the highest level.
- Exercise tact and courtesy when dealing with patients, visitors, providers, and co-workers.
- Must always adhere to customer service expectations including in-person and virtual (via telephone, or telehealth applications) communication.
- Participates in educational programs as needed.
- Bilingual English/ Spanish fluency preferred.
- Other duties as assigned.
- Maintains strictest member and company confidentiality.
Essential Job Responsibilities:
- Run daily referral reports to create work list and monitor referrals in process.
- Research chart for supporting documents and process referrals according to departmental goals, and accepted protocol, including referrals from internal GMG system, fax and mail from health plans, specialists, and other providers.
- Verify insurance eligibility and benefits from HMO eligibility lists or by contacting insurance companies by phone when needed.
- Ability to review a high volume of referral cases with CMO telephonically, enter referral information in the computer system using correct coding procedures (LCD/NCD (Local and National Coverage Determination); Document sufficient referral detail so it is clear what was requested, what occurred, what was approved, and who was notified.
- Notify patients of the referral process, authorization decisions, and verify their understanding.
- Notify referral provider of authorizations in a timely manner.
- Conducts periodic review of previously authorized ongoing care for continued need and or eligibility.
- Notify supervisor of problem referrals where turnaround goals are exceeded, or other issues are encountered.
- Acts as liaison for Managed Care and PCP when patient has questions.
- Serves as clinic information source regarding managed care and referrals.
Education and Training: Minimum high school education or equivalent. Medical Assistant Certificate preferred.
Experience: Previous experience in managed care referrals. Must have knowledge of ICD-10 and CPT-4 coding, and medical terminology.
Other Requirements: Computer Skills: Skilled in use of computer/EMR systems. Knowledge of Word processing software, spreadsheet software, Internet, and database software.
Work Environment: Depending upon the area assigned, may be 100% clinical setting, office setting in a clinical environment. Exposure to communicable diseases, bodily fluids, toxic substances, ionizing radiation, medicinal preparations, and other conditions common to a clinic environment.
Mental / Physical Requirements: Requires manual dexterity, sitting, standing, stooping, reaching, kneeling, crouching, bending, walking, lifting up to 10 lbs. Close vision and ability to adjust focus. Must be able to work efficiently under pressure.
Additional Information: Gonzaba Medical Group is seeking team members who contribute as A-Players, demonstrate a strong work ethic, are committed to the culture and our core values.
Other Duties As Assigned: The above job description is not intended to be an all-inclusive list of duties and standards of the position. Team members will follow any other instructions, and perform any other related duties, as assigned by their supervisor. Responsibilities, knowledge, skills, abilities, and work environments may change as needs evolve.
-
Assessment Referral Specialist
1 week ago
San Antonio, United States Methodist Healthcare Full time**Introduction**: Do you have the career opportunities as an Assessment Referral Specialist you want with your current employer? We have an exciting opportunity for you to join Methodist Healthcare which is part of the nation's leading provider of healthcare services, HCA Healthcare. **Benefits**: Methodist Healthcare, offers a total rewards package that...
-
Assessment Referral Specialist
1 month ago
San Antonio, United States Methodist Healthcare San Antonio Full timeDescription Introduction Do you have the career opportunities as an Assessment Referral Specialist you want with your current employer? We have an exciting opportunity for you to join Methodist Healthcare which is part of the nations leading provider of healthcare services, HCA Healthcare. Benefits Methodist Healthcare, offers a total rewards package...
-
Assessment Referral Specialist
1 month ago
San Antonio, United States HCA Full timeIntroduction Do you have the career opportunities as an Assessment Referral Specialist you want with your current employer? We have an exciting opportunity for you to join Methodist Healthcare which is part of the nation's leading provider of healthcare services, HCA Healthcare. Benefits Methodist Healthcare, offers a total rewards package that supports...
-
Assessment Referral Specialist
4 weeks ago
San Antonio, United States Methodist Healthcare San Antonio Full timeDescription Introduction Do you have the career opportunities as an Assessment Referral Specialist you want with your current employer? We have an exciting opportunity for you to join Methodist Healthcare which is part of the nations leading provider of healthcare services, HCA Healthcare. Benefits Methodist Healthcare, offers a total rewards package...
-
Assessment Referral Specialist
4 weeks ago
San Antonio, United States HCA Full timeIntroduction Do you have the career opportunities as an Assessment Referral Specialist you want with your current employer? We have an exciting opportunity for you to join Methodist Healthcare which is part of the nation's leading provider of healthcare services, HCA Healthcare. Benefits Methodist Healthcare, offers a total rewards package that supports...
-
Assessment Referral Specialist
4 weeks ago
San Antonio, Texas, United States HCA Healthcare Full timeDescription IntroductionDo you have the career opportunities as an Assessment Referral Specialist you want with your current employer? We have an exciting opportunity for you to join Methodist Healthcare which is part of the nations leading provider of healthcare services, HCA Healthcare.BenefitsMethodist Healthcare, offers a total rewards package that...
-
Assessment Referral Specialist
1 month ago
San Antonio, Texas, United States HCA Healthcare Full timeDescription IntroductionDo you have the career opportunities as an Assessment Referral Specialist you want with your current employer? We have an exciting opportunity for you to join Methodist Healthcare which is part of the nations leading provider of healthcare services, HCA Healthcare.BenefitsMethodist Healthcare, offers a total rewards package that...
-
Assessment Referral Specialist
1 month ago
San Antonio, United States HCA Healthcare Full timeDescription IntroductionDo you have the career opportunities as an Assessment Referral Specialist you want with your current employer? We have an exciting opportunity for you to join Methodist Healthcare which is part of the nations leading provider of healthcare services, HCA Healthcare.BenefitsMethodist Healthcare, offers a total rewards package that...
-
Assessment Referral Specialist
4 weeks ago
San Antonio, United States HCA Healthcare Full timeDescription IntroductionDo you have the career opportunities as an Assessment Referral Specialist you want with your current employer? We have an exciting opportunity for you to join Methodist Healthcare which is part of the nations leading provider of healthcare services, HCA Healthcare.BenefitsMethodist Healthcare, offers a total rewards package that...
-
Referral Specialist I
3 weeks ago
San Diego, United States Family Health Centers of San Diego Full time**Impact Lives, Impact Community** Family Health Centers of San Diego (FHCSD) is passionate about providing exceptional health care to all, especially underserved communities with limited health care options. Founded by a Latina grandmother/community advocate over 50 years ago in Barrio Logan, FHCSD has grown into one of the largest community health systems...
-
Referral Specialist I
2 weeks ago
San Diego, California, United States Family Health Centers of San Diego Full timeImpact Lives, Impact CommunityFamily Health Centers of San Diego (FHCSD) is passionate about providing exceptional health care to all, especially underserved communities with limited health care options. Founded by a Latina grandmother/community advocate over 50 years ago in Barrio Logan, FHCSD has grown into one of the largest community health systems in...
-
Referral Specialist
4 weeks ago
San Marcos, United States Gary and Mary West PACE Full time**_Gary and Mary West PACE is a growing and thriving all inclusive day center for the elderly._** **_ We are located in San Marcos, CA._** **_ We offer several rich benefit plans to chose from and also have a great 403B program._** **_ This a a full time position, Monday through Friday from 8:00AM-4:30PM._** **Why Work for Gary and Mary West...
-
Pds Referral Specialist
1 week ago
San Diego, United States Family Health Centers of San Diego Full timeFamily Health Centers of San Diego is looking for a Referral Specialist to complete assigned referrals for assigned department(s). Makes appointments directly into CMIS for the appropriate FHCSD site or service. Schedules translation services as needed and makes reminder calls as assigned. Provides excellent patient-centered communication and education...
-
Referral/Benefits Specialist
2 months ago
San Antonio, United States Nidraveda PA Full timeJob DescriptionJob DescriptionWe are seeking a Referral Coordinator to join our team! You will be responsible for scheduling new patients and f/u patients.Responsibilities:Schedule appointments with new patients and f/u patientsObtain authorizations for the servicesResolve patient inquiries and complaintsMaintain record of patient contact information in the...
-
Referral/Benefits Specialist
2 months ago
San Antonio, United States Nidraveda PA Full timeJob DescriptionJob DescriptionWe are seeking a Referral Coordinator to join our team! You will be responsible for scheduling new patients and f/u patients.Responsibilities:Schedule appointments with new patients and f/u patientsObtain authorizations for the servicesResolve patient inquiries and complaintsMaintain record of patient contact information in the...
-
Referral Specialist
1 month ago
San Francisco, United States Mission Neighborhood Health Center Full timeJob DescriptionJob DescriptionThe Mission Neighborhood Health Center (MNHC) is a non-profit, multi-site community health organization offering comprehensive health services in the Mission and Excelsior Districts of San Francisco. The center offers primary health care services, adult medicine, pediatrics, family planning, OB/GYN, HIV and homeless...
-
Referral Specialist
2 weeks ago
San Francisco, United States Mission Neighborhood Health Center Full timeJob DescriptionJob DescriptionThe Mission Neighborhood Health Center (MNHC) is a non-profit, multi-site community health organization offering comprehensive health services in the Mission and Excelsior Districts of San Francisco. The center offers primary health care services, adult medicine, pediatrics, family planning, OB/GYN, HIV and homeless...
-
Referral Specialist
4 weeks ago
San Francisco, United States Mission Neighborhood Health Center Full timeJob DescriptionJob DescriptionThe Mission Neighborhood Health Center (MNHC) is a non-profit, multi-site community health organization offering comprehensive health services in the Mission and Excelsior Districts of San Francisco. The center offers primary health care services, adult medicine, pediatrics, family planning, OB/GYN, HIV and homeless...
-
Referral Specialist
4 weeks ago
San Marcos, United States Gary and Mary West PACE Full timeJob DescriptionJob DescriptionGary and Mary West PACE is a growing and thriving all inclusive day center for the elderly.We are located in San Marcos, CA.We offer several rich benefit plans to chose from and also have a great 403B program.This a a full time position, Monday through Friday from 8:00AM-4:30PM.Why Work for Gary and Mary West PACE? Because you...
-
Referral Specialist
1 month ago
San Marcos, United States Gary and Mary West PACE Full timeJob DescriptionJob DescriptionGary and Mary West PACE is a growing and thriving all inclusive day center for the elderly.We are located in San Marcos, CA.We offer several rich benefit plans to chose from and also have a great 403B program.This a a full time position, Monday through Friday from 8:00AM-4:30PM.Why Work for Gary and Mary West PACE? Because you...
