Managed Care Referral Specialist I

Impact Lives, Impact Community

Family Health Centers of San Diego (FHCSD) is passionate about providing exceptional health care to all, especially underserved communities with limited health care options.

Founded by a Latina grandmother / community advocate over 50 years ago in Barrio Logan, FHCSD has grown into one of the largest community health systems in the country.

With over 62 sites, over 227,000 patients, and over 417,000 visits last year, we provide a wide variety of health care and outreach services to a very diverse patient population.

We are proud of our mission, our lasting community impact, and the cultural and individual diversity of our staff.

The Referral Specialist coordinates, processes and documents medical referrals and prior authorizations for a variety of medical services for clinic patients, as requested electronically by clinic providers.

This requires clinical knowledge and understanding of CPT and ICD-9(10) codes to meet the requirements of third-party payers and specialty clinics to ensure minimal delay in securing referral appointments or pre-authorizations.

As an integral member of the Health Care Team, the Referral Specialist manages a high volume of referrals and pre-authorizations for multiple Providers and collaborates with other Clinic Referral Specialists, Providers, MA's, Patient Service Representatives and other support staff in multiple clinic locations.

This position requires the use of clinical and administrative judgment and initiative to determine best approach for both urgent and non-urgent patient care needs.

Responsibilities :

Completes all required documentation accurately, in a timely manner, and thoroughly in accordance with department standards;

in addition, documentation complies with patients' insurance requirements.

• Meets daily referral modification productivity standards for Referral Specialists, adhering to referral processes and guidelines.
• Per referral guidelines, provide appropriate clinical information to specialist.
• Performs other duties as assigned.
• Prepares and processes all referral and pre-authorization paperwork, including gatherings pertinent information as needed via EHR, from incoming phone / email / fax messages, or from clinical team.

Contacts various clinics, facilities, and companies to obtain information to accurately complete referral / pre-authorization requests.

Requirements :

• At least 1 year of experience in ambulatory care setting or similar setting is strongly preferred.
• High school diploma or GED equivalent required.
• Medical Terminology Course required, or able to complete within 90 days of hire.
• Bilingual English / Spanish is required.

Rewards :

• Job type : Regular Full-time
• Competitive Salary with Excellent Benefits
• Retirement Plan with Employer Match
• Paid Time Off, Extended Sick Leave and Paid Holidays
• Medical / Dental / Vision / FSA / Life Insurance
• Employee Discounts and Wellness Programs

The successful candidate will have a demonstrated commitment to community medicine and providing culturally competent care to the medically underserved.

In the spirit of pay transparency, we are excited to share the base range for this position, exclusive of fringe benefits or potential bonuses.

$21.65 - $25.83

If you are hired at Family Health Centers of San Diego, your final base salary compensation will be determined based on factors such as geographic location, jurisdictional requirements, skills, education, and / or experience.

In addition to these factors - we believe in the importance of pay equity and consider internal equity of our current team members as a part of any final offer.

Please keep in mind that the range mentioned above is what we reasonably expect to pay for the role. Hiring at the maximum of the range would not be typical in order to allow for future and continued salary growth.

We also offer a generous compensation and benefits package (more information on our benefits offerings is available here : FHCSD Wellness - Employee Hub (gobenefits.net)