PACE Referrals Supervisor

San Ysidro Health; San Diego (CA); Hybrid; USD 65,000 - 90,000; Full time

Job summary

San Ysidro Health is seeking a Referrals Supervisor to support the PACE referrals process. Under supervision, you will assist referrals specialists, oversee workflow, and ensure adherence to policies and regulatory requirements for timely participant care.

You will lead staff, train on platforms like Epic and QuickCap, prepare management reports, and coordinate cross-site communication with clinic leadership to maintain quality care for PACE participants.

Qualifications

• High school diploma or GED required, plus post-high school vocational training in medical terminology or coding.
• Experience in supervisory roles in medical management (claims/referrals) preferred.

Responsibilities

• Assist in developing and implementing departmental policies and procedures to meet participant and care team objectives.
• Coordinate workload distribution and monitor productivity to meet performance goals.
• Lead investigation of issues impacting referrals and implement workflow changes to improve processes.
• Interpret and communicate changes in workflows and expectations to Referral Specialists.
• Serve as super-user for PACE platforms (Epic, QuickCap) and provide training/optimization support.
• Communicate with internal and external stakeholders regarding referrals, codes, billing, and authorizations.
• Prepare reports for management and may visit PACE sites to liaise with clinic leadership.

Skills

Supervisory experience

Medical terminology

Communication skills

Multitasking

Education

High School Diploma or GED

Medical Terminology/CPT ICD9 coding training or certificate

Tools

MS Office

Electronic Health Record (EHR) systems

Job description

Position Summary:

Under the direct supervision of the PACE Referrals Manager, the Referrals Supervisor assists the Referrals Specialists to ensure adherence to policies, procedures, and PACE regulatory requirements. The role is focused on achieving goals related to the efficient and timely processing of referrals and authorizations to ensure prompt care for PACE participants.

Essential Functions of the Job:

• Assists in the development and implementation of departmental policies and procedures to meet participant and care team objectives, fostering an efficient and quality-driven environment that meets performance and productivity goals.
• Coordinates the distribution of workload to ensure efficiency and ongoingly monitors productivity.
• Takes the lead in the investigation of issues impacting the referral process and/or PACE participants care. When necessary, implements changes in the workflow to improve the referrals process.
• Interprets and communicates changes in workflows, policies and expectations to the Referral Specialists while setting clear expectations.
• Functions as a super-user for all PACE platforms (i.e. Epic, QuickCap) that interact with the PACE referral process. Acts as an ongoing resource for training and optimization initiatives for the platforms.
• Communicates frequently with internal and external stakeholders to assist with inquiries surrounding referrals, treatment codes, billing, authorizations.
• Maintains oversight of all platforms to ensure all related data is accurate to assist in generating reports.
• Ongoingly communicates with specialty offices to provide updates regarding changes to maintain a positive relationship to enhance our PACE participants care.
• Interviews, hires, performs disciplinary action and performance evaluations for employees and maintains their schedules and time-off requests, including weekly edits as appropriate.
• Leads regular meetings to disseminate updates and to discuss any issues throughout the department. Attends meetings as required and participates in committees as directed.
• Prepares reports requested by management.
• May visit different PACE sites to maintain open communication with clinic leadership and staff.

Additional Duties and Responsibilities:

• Enhances professional growth and development through participation in educational programs, current literature, in-service meetings and workshops.
• Coverage for Referral Specialist as needed.
• Encourages creative thinking, problem solving, and empowerment as part of the facility management group to improve morale and teamwork.
• Works closely with PACE leadership to enhance the referrals department’s efficiency.
• Performs other related duties as assigned or requested

Job Requirements:

Education Required (Minimum level of education):

• High School Diploma or GED Equivalent
• Post High School Vocational/Specialized Training (Medical Terminology, CPT/ICD9 coding, Medical Assistant Certificate or Certified Procedural Coder Certificate)
• Relevant education or volunteer work may substitute for experience.

EducationPreferred:

• Bachelor’s degree in healthcare related field

Experience Required (Minimum level of experience):

• Minimum 6 months of Supervisory experience in medical management for managed care related field, such as claims, referral authorization, and front/back office.
• Preferred: 1 year of supervisory related duties in related fields.

Verbal and Written Skills Required to Perform the Job:

• Excellent oral and written communication skills.

Technical Knowledge and Skills Required to Perform the Job:

• Medical Terminology and working knowledge of Microsoft Windows, MS-Office.
• Knowledge of program and health plan eligibility, coding, data processing, and medical records.
• Ability to handle multiple activities simultaneously and able to prioritize work.

Equipment Used:

• Personal computer
• Electronic Health Record system or computerized referral system.
• Fax machine.
• Telephone devices and voicemail.

Working Conditions and Physical Requirements:

• Prolonged periods of sitting, minimum walking, and constant telephone communication.
• May be required to work evenings, holidays 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