Supervisor, Referrals

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Position Family: Support Services

Wage Range: $28.50 - $34.20 Per Hour

Who We Are:

SAC Health empowers our patients and their families to live vibrant and healthy lives through culturally responsive, exceptional care. Patient-centered, whole-person care. Our unique, full scope, team-based approach is what makes SAC Health the provider of choice for patients.

Top-Tier Patient Satisfaction Scores | Largest Teaching Health Center FQHC | 11 Locations offering 44 Specialties | NCQA Patient-Centered Medical Home Level 3 Certified
Multi-Site Approved for NHSC & NCLRP loan forgiveness programs - NHSC/Nurse Corps/Pediatric Specialty | HPSA Scores: Primary: 17 | Dental: 25 | Mental: 20

What We Are Looking For

The Supervisor, Referrals is responsible for understanding the referral/authorization process at the highest level, and supervising the referral staff to ensure compliance with processing guidelines. Ensures accurate and timely review and entry of authorizations and consult notes. Processes and ensures completion of referral orders to specialists. May place or assist in processing of orders under the direction of
approved protocols. Offers guidance to providers on the ordering of referrals, as needed. Recommends new processes to improve efficiency within the department. Monitors staff productivity and provides coaching in areas of improvement. Reports to the Referrals Manager. Occasional travel to other SAC Health clinics may be required.

Schedule: | Location: [City], CA

ESSENTIAL FUNCTIONS AND DELIVERABLES

• Responsible for initiating continuous improvement methodologies, including quality assurance reviews to ensure compliance is maintained in accordance to insurance and SAC Health guidelines.
• Handles escalated patient issues and assists in resolving.
• Identifies internal and external challenges related to referrals and recommends new processes to improve efficiency within the department. Responsible for coaching staff and identifying areas of improvement.
• Meets with staff on a regular basis, holding documented one-on-one meetings to review issues with staff and update on progress.
• Assists in the interviewing process for new staff and provides valuable input for the annual evaluation of staff.
• May place or assist in processing of orders under approved standing orders and protocols as needed.
• Reviews referral order documentation to determine if documentation supports requested referral and reviews for accuracy of codes.
• Processes referrals, authorizations, and specialty notes. Verifies accuracy of authorizations and ensures specialty notes are received timely to facilitate on-going authorizations for continued care.
• Serves as liaison and referral resource to clinic staff, outside medical groups, and patients.
• Maintains up-to-date knowledge and familiarity with insurance policies, referral, and authorization processes. Works with insurance companies / managed care groups to ensure pre-visit information is sent to patients as needed.

QUALIFICATIONS:

• Education: High School Diploma or equivalent required. Bachelor's degree preferred.
• Licensure/Certification: Valid CA driver's license and active auto insurance. As a requirement of this position you must receive EPIC certification for the module you have been hired into.
• Experience: Minimum two (2) years supervisory or leadership experience required. Two (2) years of medical office or outpatient experience preferred. Medical knowledge and experience in medical referral processing, ICD and CPT coding preferred.
• Essential Technical/Motor Skills: Must have proficient computer skills including data entry (35wpm). Must be able to use a variety of office equipment including fax machine, scanner, printer and copier.
• Interpersonal Skills: Must demonstrate the ability to foster teamwork and contribute to the development of an effective work environment; exceptional communication, organizational and office and interpersonal skills.
• Essential Mental Abilities: Requires critical thinking skills. Must be flexible to perform a variety of tasks. Must be well organized. Must be able to handle multiple telephone lines ringing simultaneously.