PACE Referrals Specialist

Position Summary:

Responsible for timely processing, documenting, and follow up of referrals and request for treatment authorizations as requested by the primary physician and contracted network providers/vendors.

Essential Functions of the Job:

• Receives and processes referrals and approvals in alignment with the minimum expectations of CMS.
• In an expeditious manner, reviews existing PACE network of providers, coordinates and schedules specialty appointments as needed.
• Obtains approvals from providers and disseminates information to participants in writing or electronic media.
• Coordinates care within the guidelines of multiple providers.
• Responds to inquiries as to status of authorizations by assessing the request and evaluating the circumstances to provide the correct information.
• Initiates the appropriate documentation of requests from specialties offices for ongoing care.
• Follows-up on missing documentation on submitted authorization requests to obtain sufficient information.
• Uses various modules of the computer system to obtain information, query information and process orders and authorizations.
• Accurately documents on the various platforms and computer systems to ensure expeditious outcomes to all requested services.
• Communicates effectively with Providers and PACE participants while coordinating referrals and specialty appointments/services. 

Additional Duties and Responsibilities:

• 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.
• Performs other related duties as assigned or requested.

Job Requirements:

Education Required (Minimum level of education):

• High school diploma or GED equivalent

Certifications/Licenses Preferred:

• Medical Terminology, CPC, coding, or Medical Assistant

Experience Required (Minimum level of experience):

• 2 years’ experience in the medical field, OR
• Bachelor’s degree, OR
• An equivalent combination of education and experience that provides the skills, knowledge, and ability to perform the essential job duties is required.

Experience Preferred:

• 2 years in health plan of clinic setting.
• One year of experience with Electronic Medical Record Systems.

Verbal and Written Skills Required to perform the Job:

• Excellent verbal and written communication skills.

Minimum Qualifications:

• Previous experience or strong desire to learn complex computer systems
• Technical proficiency with the Microsoft Office suite of applications.
• Demonstrated ability in resolving problems and communicating solutions verbally and/or in writing to the affected parties.
• Experience identifying and presenting information with tact and skill.
• Demonstrated critical thinking skills, and consistent use of analytical and problem-solving skills.
• Demonstrated ability to be culturally sensitive and respect diversity.
• Detail oriented with strong time management and organizational skills

Technical Knowledge and Skills Required to Perform the Job:

• Medical terminology and basic computer.
• Typing of 35 wpm.
• Ability to handle multiple activities simultaneously.
• Be attentive to patient needs and concerns.
• Willing to work with others as a team member.

Equipment Used:

• Personal computer, FAX, e-FAX, TruChart, Epic, QuickCap, Adobe Pro, Microsoft office

Working Conditions and Physical Requirements:

• Prolonged sitting position, walking, constant telephone and email communication.
• May be required to work evenings, holidays and/or weekends.

Universal Requirements

Pre employment requirements include I-9, physical, positive background and reference check results, complete application, new hire orientation, pre-employment PPDs.