Managed Care Referral Specialist I

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 in the country. With over 90 sites, over 227,000 patients, and over 1.1 million healthcare visits last year, we provide a wide variety of health care and outreach services to a very diverse patient population. We are proud of our mission, our lasting community impact, and the cultural and individual diversity of our staff.

General Job Description

*The Referral Specialist coordinates, processes and documents medical referrals and prior authorizations for a variety of medical services for clinic patients, as requested electronically by clinic providers. This requires clinical knowledge and understanding of CPT and ICD-9(10) codes to meet the requirements of third party payers and specialty clinics to ensure minimal delay in securing referral appointments or pre-authorizations. As an integral member of the Health Care Team, the Referral Specialist manages a high volume of referrals and pre-authorizations for multiple Providers and collaborates with other Clinic Referral Specialists, Providers, MA's, Patient Service Representatives and other support staff in multiple clinic locations. This position requires the use of clinical and administrative judgment and initiative to determine best approach for both urgent and non-urgent patient care needs.

Job Roles

*Completes all required documentation accurately, in a timely manner, and thoroughly in accordance with department standards; in addition, documentation complies with patients' insurance requirements.

*Meets daily referral modification productivity standards for Referral Specialists, adhering to referral processes and guidelines.

*Per referral guidelines, provide appropriate clinical information to specialist.

*Performs other duties as assigned.

*Prepares and processes all referral and pre-authorization paperwork, including gatherings pertinent information as needed via EHR, from incoming phone/email/fax messages, or from clinical team. Contacts various clinics, facilities, and companies to obtain information to accurately complete referral/pre-authorization requests.

Education/Certifications/Licenses/Registrations

*At least 1 year of experience in ambulatory care setting or similar setting is strongly preferred.

*High school diploma or GED equivalent required.

*Medical Terminology Course required, or able to complete within 90 days of hire.

Experience/Specialized skills (including Language)

*Ability to maintain good interpersonal interactions with clients and co-workers as a member of a multi-disciplinary community health team with a diverse multi-cultural population.

*Ability to multi-task, be flexible, ensure accuracy, and meet changing priorities in a fast-paced, high-workload environment.

*Basic computer literacy (i.e., use system to manage and schedule appointments, access electronic medical record information).

*Basic organizational skills, attention to detail, time-management skills, and strong motivation to meet deadlines and achieve goals.

*Bilingual in Spanish/English preferred.

*Clinical knowledge of medical terminology, medical procedures, CPT, and ICD-9 (10).

*Intermediate knowledge of insurance providers, their portals and their expectations for authorization approval.

*Intermediate written and verbal communication skills, including ability to communicate effectively with patients and family members who speak English as a second language.

Physical Requirements/Working Environment

Bending (neck): RARELY (0-1 HRS)

Bending (waist): NEVER

Carrying 0 - 10 lbs: FREQUENTLY (3 - 6 HRS)

Carrying 11 - 25 lbs: NEVER

Carrying 25 - 50 lbs: NEVER

Carrying 51 - 75 lbs: NEVER

Carrying 75 lbs: NEVER

Climbing (ladder): NEVER

Climbing (stairs): RARELY (0-1 HRS)

Driving: To drive from one clinic or another, or in the community: NEVER

Exposure to blood borne pathogens and biohazards: NO

Exposure to dust, gas, fumes, or chemicals: Office supplies.

Fine manipulation: FREQUENTLY (3 - 6 HRS)

Kneeling: NEVER

Lifting 0 - 10 lbs: FREQUENTLY (3 - 6 HRS)

Lifting 11 - 25 lbs: NEVER

Lifting 25 - 50 lbs: NEVER

Lifting 51 - 75 lbs: NEVER

Lifting over 75 lbs: NEVER

Power Grasping: NEVER

Pulling 0 - 10 lbs: FREQUENTLY (3 - 6 HRS)

Pulling 11 - 25 lbs: NEVER

Pulling 25 - 50 lbs: NEVER

Pulling 51 - 75 lbs: NEVER

Pulling over 75 lbs: NEVER

Pushing 0 - 10 lbs: FREQUENTLY (3 - 6 HRS)

Pushing 11 - 25 lbs: NEVER

Pushing 25 - 50 lbs: NEVER

Pushing 51 - 75 lbs: NEVER

Pushing over 75 lbs: NEVER

Reaching (above shoulder level): NEVER

Reaching (below shoulder level): RARELY (0-1 HRS)

Repetitive use of hand: CONSTANTLY (6+ HRS)

Simple Grasping: FREQUENTLY (3 - 6 HRS)

Sitting: CONSTANTLY (6+ HRS)

Standing: RARELY (0-1 HRS)

Twisting: NEVER

Use of Personal Protective Equipment: NO

Walking: RARELY (0-1 HRS)

Working around equipment and machinery: Office equipment

Ages of Patients Served: N/A

In the spirit of pay transparency, we are excited to share the base range for this position, exclusive of fringe benefits.

If you are hired at Family Health Centers of San Diego, your final base salary compensation will be determined based on factors such as geographic location, jurisdictional requirements, skills, education, and/or experience. In addition to these factors - we believe in the importance of pay equity and consider internal equity of our current team members as a part of any final offer. Please keep in mind that the range mentioned above is what we reasonably expect to pay for the role. Hiring at the maximum of the range would not be typical in order to allow for future and continued salary growth. We also offer a generous compensation and benefits package (more information on our benefits offerings is available here: FHCSD Wellness - Employee Hub (gobenefits.net)