Referral Specialist Lead

• Gather, verify, and process referrals, authorizations, and pre-certifications by working closely with physician(s), patients
  and insurance payers.
• Communicate detailed information and answer patient questions regarding their health care plan; provide answers to
  billing and insurance clarification questions.
• Set up appointments, coordinate clinic visits, and any special arrangements such as transportation, interpreter services,
  specialty care, etc.
• Coordinate flow of information between medical clinic and referral authorization department to secure a valid referral for
  clinic patients.
• Enter referrals, documents, communications and action into the system, as appropriate.
• Prioritizes referrals by their urgency and addresses them in a timely manner.
• Notify physician(s) and patient when referral is denied, or if additional information is needed.
• Develop and maintain a database of referral physician offices preferred by each physician within the clinic.
• Assist Practice Manager with complaint resolution and solutions related to patient referrals.
• Process HMO and Cencal requests submitted by Specialty Physicians for additional services.
• Coordinates patient instructional/educational activities relevant to the patient's referral.
• Point of contact for patients and specialists for any questions or rising concerns. Assist in problem solving potential issues
  related to their referral due to language or social barriers. If unable to help, assist in finding the right point of contact to
  further help.
• Maintaining a processing average and minimum of 400-450 referrals a month.
• Participate in training new referral coordinators.
• Supports the department management team.
• Supports the referral team ensuring they are staying on track and is their initial go to for questions or concerns.
• Perform other duties as assigned by the practice manager or physician.

Minimum Qualifications:

2-3 years related experience in a healthcare environment and 2-3 years experience processing referrals

Preferred:

• History in patient scheduling/registration, insurance verification and referral coordination
• Strong customer service focus
• Resourcefulness in problem solving
• Effective verbal and written communication skills
• Teamwork orientation
• Organized record keeping
• Able to take and follow through with delegated tasks and accountability

Dignity Health’s Pacific Central Coast Health Centers (PHC) is a non-profit Community clinic organization comprised of more than 40 health centers located primarily from Ventura to Templeton, spanning the coast. Our experienced physicians and advanced practice providers offer a wide range of primary and specialty care services. PHC is a part of Dignity Health Central Coast’s award-winning network of outstanding hospitals, imaging centers, laboratories, and post-acute services.

One Community. One Mission. One California