Position Summary:
Referrals Specialist Lead provides assistance in monitoring the functions of the Referral Specialist. Works closely with the Referrals Department Supervisor and Manager to assure the quality improvement goals, objectives, appropriateness and timeliness of the referral process to be met on a day to day basis as well as providing the guidance to the team when need arises.
Essential Functions of the Job:
- Assists Referral Specialists in managing difficult cases to obtain appropriate care for the patient.
- Lead is contacted for troubleshooting on patient or provider inquiries/concerns and any barriers to compliance.
- Acts as lead contact to address concerns and questions for other Referral Specialists in the department.
- When necessary, assists in implementing changes in the workflow to improve the processing of referrals.
- Assists in monitoring appropriate coding and documentation of referral activity.
- Receives and processes authorizations on timely manner with the at most attention to quality, accuracy and completeness of work. Plans in advance to ensure task are complete and seeks to add value to every work assignment. Schedules requests for referrals and treatment authorizations.
- Demonstrates skills and knowledge to obtain authorizations from various insurance carriers via phone, in writing or electronic media, adjusting effectively to organizational changes maintaining high standards.
- Coordinates care within the guidelines of multiple health plans, contracts or insurance types. Uses various modules of the computer system to obtain information, schedule appointments, query information and obtain authorizations.
- Responds to inquiries as to current status of authorization by assessing the request and evaluating the circumstances to provide regular, consistent, timely, and meaningful information to our patients. Demonstrates professionalism verbally and non-verbally, tailors communication styles to the need of the recipient.
- Listens to customers (internal and external) and addresses needs; accountable and responsive to customers concerns. Seeks different points of view and leverages diverse perspectives. Meets established or agreed upon deadlines.
- Arrives on time and prepared for work; uses sound judgement to meet and exceed workplace expectations; assumes responsibility and accountability for decisions, actions, and performance.
- Work on closing the referrals loop; review the referral log weekly to determine which patients have kept their specialty or consultation appointments and share with the team.
- Update the referral with date and time of the appointment. Document if patient kept their appointment, reach out to Specialist or Facility to request visit notes or results to be faxed to Referrals main fax number within 5 working days of visit.
- Manage Referrals Team and provide effective guidance. Will be responsible for leading, guiding, training and motivating team members on a daily basis.
- As a team leader, be the contact point for all team members. Therefore, communication skills should be excellent. Also be able to act proactively to ensure smooth team operations and effective collaboration.
- Create an inspiring team environment with an open communication culture, Set clear team goals, Delegate tasks and set deadlines, Oversee day-to-day operations, Monitor team performance and report on metrics, Motivate team members, Discover training needs and provide coaching, Listen to team members' feedback and resolve any issues or conflicts, and keep Supervisor informed and updated, Recognize high performance and reward accomplishments, Encourage creativity, Suggest and organize team building activities.
- Running/monitoring daily and weekly referrals reports to ensure referrals are being processed within the respective timeframe.
- Assist on preparing productivity reports requested by Supervisor/Managers on a daily basis for monitoring and/or for audits as needed.
- Assist with the training of new staff and existing Referral Specialists with technical updates and guidance to maintain quality measures to San Ysidro Health standards.
- Provide guidance to new hires with orientation to our Policies and Procedures, onboarding and provide regular updates to Supervisor/ Manager on new staffs.
- Assist on preparing presentations for monthly meetings and created handbooks for training purposes as needed.
- Assist with workload distribution to ensure there is coverage necessary when needed.
- Monitor co-workers daily duties, workflows and create workload assignation schedules.
- Monitor projects workloads and coordinate workflow.
- Help with the IRR for staff to have the same training tools and trainable referral knowledge.
- Support the interviews process for new hires, by facilitating the typing test, welcoming the candidate for a smooth successful interviewing process.
- Foster uphold office above satisfactory level including the efficiency service to patients and co-workers.
- Perform weekly morning huddles with Team to provide updates and also receive feedback valuable from staff and share with Supervisor/ Manager for guidance as needed.
- Assist on providing any assistance on gathering valuable data when needed for PCMH or any other programs as required or requested.
- Lead by setting a good example and engage the team to achieve goals.
Additional Duties and Responsibilities:
- Maintains established departmental policies and procedures. Displays and promotes behavior consistent with SY Health; adheres to standards of ethical conduct and professional compliance.
- Enhances professional growth and development through participation in educational programs, current literature, in-service meetings and workshops; modeling a high performance work ethic and constant self-improvement.
- Attends meetings as required and participates in committees as directed; works cooperatively with others to meet shared objectives. Fosters an environment that encourages group participation and inclusiveness. Takes initiative to improve processes and identify root causes: maintaining a focus on solutions.
- Performs other related duties as assigned or requested by Supervisor and/or Manager.
Job Requirements
Education Required:
High school diploma or GED equivalent.
Certifications/Licenses Required:
Valid CA driver's license and access to an insured vehicle. Local travel to other clinics is required
Experience and Required Skills:
A minimum of 1 year experience in healthcare setting to include front with back office or referral authorization knowledge of programs and health plans eligibility and guidelines. Coding, data processing, or a Medical Assistant certification preferred.
Equipment used:
Personal vehicle, computers, phones, copy machines, fax machines, EPIC, and other general office equipment.
Working Conditions and Physical Requirements:
- Prolonged sitting, walking, constant telephone communication.
- Will be required to travel to other sites or locations in San Diego County.
- May be required to work evenings and/or weekends occasionally, on an as-needed basis.
Universal Requirements:
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.