Job description

Position Summary:
Responsible for timely processing, documenting, scheduling and follow up of referrals and request for treatment authorizations as requested by the primary physician.

Essential Functions of the Job:

• Receives and processes authorizations on timely manner with the at most attention to quality, accuracy and completeness of work. Plans in advance to ensure task are complete and seeks to add value to every work assignment. Schedules requests for referrals and treatment authorizations.
• Demonstrates skills and knowledge to obtain authorizations from various insurance carriers via phone, in writing or electronic media, adjusting effectively to organizational changes maintaining high standards.
• Follows-up on missing documentation to obtain authorization when appropriate; schedules appointment for specialty care, special studies, Durable Medical Equipment (DME) or other ancillary services as requested by the primary care physician.
• Coordinates care within the guidelines of multiple health plans, contracts or insurance types. Uses various modules of the computer system to obtain information, schedule appointments, query information and obtain authorizations.
• Arrives on time and prepared for work; uses sound judgement to meet and exceed workplace expectations; assumes responsibility and accountability for decisions, actions, and performance.
• Work on closing the referrals loop; review the referral log weekly to determine which patients have kept their specialty or consultation appointments.

Additional Duties and Responsibilities:

• Enhances professional growth and development through participation in educational programs, current literature, in-service meetings and workshops; modeling a high performance work ethic.
• Location shifts are required based on the need of the department; in providing coverage and or for self-improvement trainings as deemed necessary by Supervisor or Manager.
• Performs other related duties as assigned or requested by Supervisor or Manager.

Job Requirements:
Education Required (Minimum level of education): High school diploma or GED equivalent.
Required Certifications/Licenses: Current valid California driver’s license, car insurance and or proof of reliable transportation.
Experience Required: A minimum of 6 months experience in healthcare setting to include front with back office or referral authorization knowledge of programs and health plans eligibility and guidelines, coding and data processing or Medical Assistant Certificate. In conjunction with a minimum of 2 year Customer Service.
Preferred: 2 years in healthcare setting
Verbal and Written Skills Required to Perform the Job: Bilingual (English/Spanish). Good verbal and written communication skills in both languages.
Technical Knowledge and Skills Required to Perform the Job: Medical terminology and basic computer. Typing of 35 wpm. Ability to handle multiple activities simultaneously. Be attentive to patient needs and concerns. Willing to work with others as a team member.
Equipment Used: Personal computer, NextGen, and FAX.
Working Conditions and Physical Requirements: Prolonged sitting position, walking, constant telephone communication. May be required to work evenings and/or weekends.
We Offer a Dynamic and Diverse Work Environment. Benefits are an important part of our employee value proposition:

• Annual Merit Increases
• Affordable Medical, Dental, and Vision Coverage
• Paid Holidays and a Floating Holiday
• Ten Paid Vacation Days Annually
• Paid Sick Leave
• $1,000 Annually of Education Reimbursement
• 403b Retirement Plan and 162 Bonus Plan

About Us San Ysidro Health is a Federally Qualified Health Care organization committed to providing high quality, compassionate, accessible and affordable healthcare services for the entire family. The organization was founded by seven women in search of medical services for their families and community. Almost 50 years later, San Ysidro Health now provides innovative care to over 108,000 patients through a vast and integrated network of 47 program sites across the county. San Ysidro Health could not serve our patients without the dedication of our passionate and hardworking employees. Apply today and become a part of our mission-driven team! San Ysidro Health has a long-standing commitment to equal employment opportunity for all applicants for employment. Employment decisions including, but not limited to, those such as employee selection, performance evaluation, administration of benefits, working conditions, employee programs, transfers, position changes, training, disciplinary action, compensation, and separations are made without regard to race, color, religion (including religious dress and grooming), creed, national origin, nationality, citizenship status, domestic partnership status, ancestry, gender, affectional or sexual orientation, gender identity or expression, marital status, civil union status, family status, age, mental or physical disability (including AIDS or HIV-related status), atypical heredity cellular or blood trait of an individual, genetic information or refusal to submit to a genetic test or make available the results of a genetic test, military status, veteran status, or any other characteristic protected by applicable federal, state, or local laws.

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