PACE REFERRAL TRACKING COORDINATOR

NORTH EAST MEDICAL SERVICES; Daly City (CA); On-site; USD 34,000 - 49,000; Full time

Benefits offered by this job

Free medical, dental and vision for员工及

401(k) contribution

Job summary

NORTH EAST MEDICAL SERVICES in Daly City, CA is seeking a PACE Referral Tracking Coordinator I to manage medical referrals from start to finish. You will verify eligibility, obtain authorizations, coordinate with hospitals and providers, and document progress in Epic to keep the care team informed.

This full-time role requires strong communication, attention to detail, and the ability to multitask in a fast-paced environment. Fluency in English is required; Cantonese/Mandarin are a plus.

Qualifications

• Strong communication skills (written and verbal) to support documentation and progress tracking.
• Ability to multitask in a busy healthcare environment.
• Excellent data entry skills and attention to detail.
• Experience with integrating insurance information and prior authorizations is preferred.

Responsibilities

• Process medical referrals for PACE insurances according to program requirements.
• Submit complete referral packets including prior authorizations when needed.
• Track referral status and obtain consultation reports to close the referral loop.
• Follow up on outstanding referrals and liaise with the PACE care team.
• Provide accurate referral details to the care team, including provider and specialty information.
• Triage inquiries and escalate missing information to processing staff.
• Enter referral activities in the patient’s EMR with notes and relevant data.
• Perform other duties as required by management.

Skills

Communication

Multitasking

Attention to detail

Data entry

Education

High School Diploma

AA or higher preferred

Tools

Epic EHR

Job description

Job DetailsJob Location: Daly City, CA 94014Salary Range: $30.00 - $30.00 Hourly

The PACE Referral Tracking Coordinator (RTC) I is responsible for the processing of all medical referrals initiated by NEMS PACE providers from start to finish, which includes verifying patient’s eligibility and coverage information from various insurance plans, obtaining prior authorizations when needed, communicating with hospitals and specialty providers’ offices to follow up referral requests, confirming completion of visits by obtaining consultation notes, documenting progress in Epic EHR system to keep PCPs and care team informed. The PACE RTC-I is responsible for the tracking of all the in-progress medical referrals and performing additional needed activities to ensure referrals initiated by PACE providers are followed through according to TAT (Turnaround Time) requirement.

This position requires good communication and public relations skills to build rapport and relationships with counterpart staff at external specialist offices and hospitals to facilitate a smooth close-the-loop process. The PACE RTC I will work collaboratively with NEMS call center and clinical team, external provider/vendor offices and hospital staff to promote workflow efficiency and team performance.

ESSENTIAL JOB FUNCTIONS:

• Timely processing of medical referrals for PACE insurances according to PACE program requirements.
• Obtain clinical information relevant to the patient’s referral and submit a complete packet of referral documents, including the approved Prior Authorization when appropriate, to external provider’s office to avoid delays in patient care.
• Track referral status and obtain consultation reports/results to close the referral loop when needed.
• Follow-up on the outstanding referrals report and contact PACE care team to determine if patients still need/want the requested service.
• Provide PACE care team with accurate information regarding the referral, including specialty type, name of the specialty provider, address, phone number, and a copy of the referral, if appropriate.
• Triage inquiries on referral status and communicate timely with the PACE care team if additional information is needed to process the referral.
• Enter all referral related activities and communications in the patient’s Electronic Medical Record, including notes and any relevant information as it relates to the referral.
• Performs other job duties as required by manager/supervisor

Qualifications

• High School Degree required AA or higher preferred or can be substituted with minimum of 2 years of experience in customer services and/or healthcare related field required
• Good communication skills (both written and verbal) is required to support system documentation and progress tracking.
• Prior experience working in healthcare setting with knowledge of handling different types of insurance, e.g., Medi-Cal, Medicare, private insurance, is preferred.
• Knowledge of medical terminology is a plus.
• Ability to follow directions with minimal supervision.
• Ability to multitask in a busy environment is a must.
• Strong attention to detail.
• Excellent data entry skills.

LANGUAGE:

• Must be able to fluently speak, read and write English.
• Fluent in Chinese (Cantonese and/or Mandarin) is preferred.
• Fluency in other languages is an asset.

STATUS AND SCHEDULE:

• This is an FLSA Non-exempt position.
• This is not an OSHA high-risk position.
• This is a Full Time position.

NEMS is proud to be an Equal Opportunity Employer welcoming diversity in our workforce.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

NEMS BENEFITS:

• Competitive benefits, including free medical, dental and vision insurance for employee, spouse and/or children; and company contribution to 401(k).