Referral & Authorization Specialist

Neighborhood Healthcare; Escondido (CA); On-site; USD 30,000 - 41,000; Full time

Job summary

Neighborhood Healthcare is seeking a Referrals and Authorizations Clerk to coordinate referrals and follow-up care for clinic patients. The role involves processing referrals, scheduling, and communicating details to patients, while using EMR systems to track status and authorization progress.

The position requires at least a high school diploma and 1 year of related experience; bilingual abilities (English/Spanish or English/Arabic) are highly preferred.

Qualifications

• High School Diploma/GED required.
• 1 year patient services/referrals experience in medical office environment preferred.
• Bilingual English/Spanish or English/Arabic highly preferred.

Responsibilities

• Performs eligibility checks as necessary electronically and/or via telephone
• Prepares, processes, and completes referrals accurately and in a timely manner
• Communicates referral details, appointment information and instructions to patient/family
• Tracks referrals in the designated logs and/or electronically via Electronic Medical Records (EMR)
• Follows up as needed on submitted authorization requests and maintains consistent status updates of efforts via EMR
• Monitors and reports on status of authorization requests, escalating issues as necessary, until fully resolved and referral loop is closed
• Proactively manages needs for re-authorization across all clients and payors, working closely with clinical teams to ensure timeliness re-authorization ahead of expiry to avoid lapses in authorization or delays in patient care
• Submits retro-authorizations and distinguishes between primary care and internal specialty visits
• Documents all actions taken in the patient medical record in accordance with current Clinic, DHS and health plan regulations/guidelines
• Advocates and discusses with patients all aspects of the referral process as needed or requested by the treating provider, including counseling patients regarding the cost of a referral, explaining insurance barriers and offering next step solutions to patient and referring provider
• Screens and answers related referral calls by telephone, text message, patient portal, and/or by mail
• Acts as a liaison between patient, clinic/providers, specialty care providers, health plans/funding sources, and community resources

Skills

Eligibility checks

Referral coordination

Patient communications

HIPAA compliance

Bilingual EN/ES

Education

High School Diploma/GED

Tools

EMR system

Job description

Neighborhood Healthcare is seeking a Referrals and Authorizations Clerk to coordinate referrals and follow-up care for clinic patients. The role involves processing referrals, scheduling, and communicating details to patients, while using EMR systems to track status and authorization progress.

The position requires at least a high school diploma and 1 year of related experience; bilingual abilities (English/Spanish or English/Arabic) are highly preferred.