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Referral Specialist
4 months ago
**_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 PACE?**
Because you desire work/life balance and have a passion to make a difference in the lives of North County seniors and their families
You will receive generous pay and a benefits program focused on your health and wellness that includes 10 paid holidays, 3 weeks of PTO, a 5% employer-match to our 403b retirement program, and no on-call time.
Because we encourage professional development and support all staff to expand their skillset, providing an annual education allowance.
You will be part of a distinct company culture where work feels like family and collaborate with a multi-disciplinary team environment where you are appreciated and valued.
Come do your best work where your contribution matters
**About PACE**
We're looking for passionate healthcare providers who want to be part of a team dedicated to enable seniors to live in their communities as independently as possible by providing compassionate, comprehensive health and supportive care.
**One Team One Mission**
**Position Summary**:
Under the direction supervision of the PACE Clinical Services Director, the PACE Referral Specialist is responsible for coordinating and processing medical, dental, and optical referrals and authorizations for a variety of settings that PACE participants utilize. This requires the understanding of universal codes such as Current Procedural Terms (CPT), Healthcare Common procedure Coding System (HCPCS), and Durable Medical Equipment, Prosthetics, Orthotics, ad Supplies (DMEPOS) in addition to International Classification of Diseases (ICD-10). These codes will meet the requirements for specialty services to ensure mínimal delay in securing accessibility for participants.
**Essential Functions**:
- Receives and processes referrals and authorizations in a timely manner.
- Coordinates care with primary care providers and their clinical coordinators in obtaining the necessary documentation needed for outsources care and diagnostics/radiology.
- Interfaces with specialty offices to answer questions in regards to referral and authorization statuses.
- Navigate and utilize multiple functions from an electronic medical record platform in producing a comprehensive referral that will satisfy the needs of specialists.
- Obtain, receive and transfer participant's medical records to and from providers outside of PACE, assuring that proper medical release forms are complete and scan paper documents into the EMR.
- Use clinical and administrative judgement under regulations to determine best approach for both urgent and non-urgent patient care needs.
- Maintain HIPAA standards and adhere to policies and procedures that govern the confidentiality of healthcare sensitive information.
- Request additional medical records from specialty offices and clinic for further review by Utilization and Network Manager and/or PACE Medical Director as needed.
- 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.
- Ability to multi-task, be flexible, ensure accuracy, and meet changing priorities in a fast-paced, high-workload environment.
- Ability to work with others as a core centralized team in addition to maintaining good interpersonal interactions with clients as a member of a multi-disciplinary community health team with a diverse multi-cultural population.
- Adheres to Gary and Mary West PACE core values and behaviors of Excellence, Empowerment, Integrity, and Respect.
- Performs other duties as required or requested in a positive and helpful manner to ensure a smooth-running work area.
- Adheres to all GMWP Policies and Procedures, GMWP Safety Policies and Procedures and OSHA safety guidelines.
- Must demonstrate regular attendance and punctuality.
- Brings issues and process improvement ideas to the attention of the Supervisor.
- Maintains verbal and written skills required for the position.
- Completes annual trainings as required.
- Adheres to Company Dress Code Policy.
- Demonstrates appropriate level of time management in support of co-workers and the entire team.
**Education and Certification**:
- High school diploma or GED equivalent required.
- Medical Terminology Certification preferred.
- Medical Assistant Certificate preferred.
**Skills & Experience**:
- One year of health care experience working with frail and/or chronically ill elderly population.
- One year experience in a hea
