This combined role involves processing referrals for managed care plans to secure authorization and schedule appointments, while also providing case management services for chronic diseases and preventative programs. Responsibilities include maintaining updated knowledge of referral processes and state regulations, communicating with providers, and assisting with organizational development for the referral process.
Requirements summary
Candidates must be bilingual in Spanish and English and possess excellent verbal and written communication skills, along with strong organizational and documentation abilities. Qualifications include either a Bachelor's degree in human services or a high school diploma/GED plus four years of referral processing experience.
bachelor degreehigh schoolCase ManagementCustomer ServiceDocumentationReportingBilingualData CollectionEnglishTrackingSpanishReferral ProcessingOrganizational DevelopmentMedical RecordsMedicareMedicaidManaged Care ReferralsCHP Plus
Job description
What We Offer
Comprehensive Benefits:
Medical
Dental
Vision
FSA/HSA
Life and Disability
Accident/Hospital Plans
Retirement with Employer Contributions
Vacation, sick, and extended illness time off options
Open communication with leadership and mission-focused engagement
Training and growth opportunities with a supportive team invested in your success
Compensation
Approximately $21.00 - $26.60 per hour. All individual pay rates are calculated based on the candidate's experience and internal equity.
Overview of role
*Must be bilingual in Spanish and English.
**Combined position that is both Medical Records and Referral Case Manager**
You will assure an effective and efficient process is available for patients who need access to specialty care. You will be responsible to maintain up to date knowledge of the managed care referrals process, specialty programs, and state rules and regulations for Medicaid, Medicare, and CHP Plus. There will also be the opportunity to assist with organizational development to maintain an effective referral process, ensure proper data collection, and create necessary reports.
Essential duties and responsibilities
Process referrals for managed care plans, specialty programs such as CCHN, to receive authorization and schedule needed appointments.
Maintains up to date knowledge of managed care referrals process, specialty programs and state rules and regulations for Medicaid, Medicare and CHP Plus.
Provides case management services to assure all needed information is obtained to facilitate an effective referral.
Provides case management for all chronic diseases and preventative programs as requested.
Updates and monitors all referrals being tracked per the time line specified in the referral procedure.
Communicates with providers regarding pending referrals and issues pertaining to processing requested referrals
Benefits
Vacation
Medical
Dental
Vision
Sick time
FSA/HSA
Life and Disability
Extended illness time off
Accident/Hospital Plans
Retirement with Employer Contributions
Collects data and writes reports as requested.
Assist with organizational development to maintain an effective referral process.
Provides information/training to the clinic staff in regards to changes in referral process, change in no payer source referral, and state rules and regulation changes.
Will work at another site as deemed necessary by the Clinic Director.
Provides superb customer service to all customers (coworkers, out side customers).
Request support from professional staff when needed.
Position qualifications
Education and Experience
1. Bachelor’s degree in the human services field desired. 2. Or high school diploma/GED and four years in referral processing.
Knowledge, Skills and Abilities
1. Excellent verbal and written communication skills in English and Spanish required. 2. Ability to flourish independently and in a team management system. 3. Sensitivity to low income, ethnic minority community. 4. Excellent organizational skills. 5. Excellent tracking, and documentation. 6. Excellent attendance.
We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status. We are proud to be an equal opportunity workplace.
