Benefits:

401(k)

Dental insurance

Health insurance

Paid time off

JOB SUMMARY Under the direct supervision of the PACE Director of Clinical Services, the PACE Referral Coordinator is responsible for receiving, processing, scheduling, and following up on all medical referral requests, including in-house and outside referrals for diagnostic testing, medical specialists, or other providers.

RESPONSIBILITIES

Serves as the main point of contact for providers and clinic staff regarding referrals, authorizations, and appointment scheduling

Prepares, processes, and completes referrals accurately and in a timely manner, including urgent and stat referrals for assigned PACE location

Arranges transportation for participants to medical appointments at High Desert PACE and other organizations, including escort coordination

Communicates referral details and appointment information/instructions to participants and their families

Tracks referrals in the designated logs and/or electronically via electronic medical records (EMR)

Follows up on submitted authorization requests and maintains consistent status updates via EMR

Request additional medical records from specialty offices and clinic for further review by Director of Clinical Services and/or PACE Medical Director as needed.

Verify Medi-Cal Eligibility, as needed

Monitors and reports on statuses of authorization requests; escalates issues as necessary until fully resolved and referral loop is closed.

Completes surgery scheduling with proper CPT codes and all needed follow ups, including pre and post order management, labs, EKG, images, etc.

Manages needs for re-authorization across all clients and payors by working with clinical teams to ensure timeliness re-authorization ahead of expiry to avoid lapses in authorization or delays in patient care.

Reviews consultation reports for needed follow up requests and works with providers to ensure timely processing of all follow ups.

Works with the health information department to ensure timely retrieval of consultation reports

Reschedules missed appointments and notifies the provider according to no show policies

Arranges the retrieval of CD images and provides to medical specialist to ensure appointment are kept and completed

Interfaces with specialty offices to answer questions in regard to referral and authorization statuses

Participates in scheduled department meetings

Shares accountability for overall participant health outcomes, working in coordination with care teams

Submits retro-authorizations and distinguishes between primary care and internal specialty visits

Documents all actions taken in the participant medical record in accordance with current Clinic, DHCS and CMS regulations/guidelines

Advocates and discusses with participants all aspects of the referral process as needed or requested by the treating provider

Screens and answers related referral calls by telephone, text message, patient portal, and/or by mail

Acts as a liaison between participant, clinic/providers, specialty care providers, hospitals, and other community resources

Makes assigned reminder calls

Performs other duties as assigned

EDUCATION & TRAINING

Previous experience in healthcare coordination, case management, or similar role.

Knowledge of Medicare and Medicaid eligibility criteria and healthcare regulations.

Strong communication and interpersonal skills, with the ability to interact effectively with diverse populations.

Excellent organizational skills and attention to details

Proficiency in Microsoft Office Suite and electronic health record systems.

SKILLS & ABILITIES

Obtains referrals and authorizations from providers in timely manner

Communicates referrals and authorizations information and pertinent medical information to the specialty provider

Enters required data, including basic insurance and screening information

Follows established protocols for patients who indicate they are in crisis