Referral Manager in Los Angeles, California at South Central Family Health Cent

Title: Referral Manager

Base Salary Range: $70,000 – $75,000 plus benefits

FTE: Full-time, Exempt

We seek a dynamic and experienced Referral Manager who wants to make a difference in our community. We want to hear from you if you thrive in a fast-paced, caring, and compassionate environment!

Our Mission: The Mission of South-Central Family Health Center is to improve the quality of life for the diverse community of inner-city Los Angeles by providing affordable and comprehensive health care and education in a welcoming and multicultural environment. To lead the way in health care in South Los Angeles, as the premier provider and employer of choice offering comprehensive, high-quality, affordable, efficient, and culturally responsive services.

General Summary: Supervise and maintain a caseload of clients enrolled in health care programs. Provides leadership to the Referrals team and assists in implementing policies and protocols.

• Supervise the daily operations of the referral department, ensuring high-quality and timely processing of referrals to minimize delays and reduce insurance denials.
• Oversee and manage staff performance, including training, coaching, scheduling, conducting evaluations, and administering disciplinary actions as necessary to support team effectiveness and accountability.
• Ensure timely processing of internal and external referrals and authorizations in accordance with organizational policy and payer requirements.
• Ensure compliance with HIPAA and other federal/state regulations related to patient information and referrals.
• Prepare for and actively participate in internal and external audits, ensuring referral department compliance with organizational policies and regulatory standards.
• Collaborate with the compliance department and other relevant teams to respond to and resolve patient grievances and complaints in a timely and professional manner, ensuring patient satisfaction and adherence to regulatory standards.
• Assist providers, members and/or internal patients with cases pertaining to referral questions, issues, and authorizations
• Reconcile claims and pended issues in a timely manner per health plan/department procedures
• Follows up on all specialists’ reports for medical providers
• Conducts culturally appropriate Multi-Component Care Plans and update as need on a quarterly basis
• Participates in case conferences and provide input related to care issues
• Receive and review incoming phone and case management log reports and determine course of action (i.e., set up authorization or denial per Clinical Director and /or plan guidelines).
• Develops and implements a client-centered, proactive Care Model
• Attendance and punctuality are essential in order to provide quality of care to patients, face-to-face interaction with patients, and to work with provided healthcare equipment collected at clinics

Qualifications and Requirements:

• High School Diploma or equivalent required
• BA Degree, required
• Demonstrate knowledge of safety, infection control & emergency policies and procedures

Experience & Abilities:

• Must have a minimum of 2 -3 years in a medical setting
• Working knowledge of medical terminology preferred
• Type 45 wpm
• Bi-lingual/bi-literate English/Spanish preferred
• Conduct oneself with professionalism in dealing with sensitive and confidential issues
• Follow up on assignments, show initiative, be self-motivated, and have a strong work ethic

Top benefits or perks: As a team member at South Central Family Health Center, you’ll enjoy competitive wages and generous benefits:

• Benefits: Health care, dental, life insurance
• 403 (b) Retirement plan
• Education Reimbursement