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
- 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).