Southwest Care Center employees can answer yes to these 3 questions:
1. Do you want to make a difference?
2. Do you believe everyone is entitled to quality healthcare?
3. Do you desire to serve the underserved in your community?
For over 25 years, Southwest Care Center has been providing exceptional healthcare to the communities of Santa Fe and Albuquerque, NM. We are a non-profit, FQHC-LAL providing medical, behavioral health, case management, community outreach, diabetes education, and pharmacy services. We are proud to offer gender equity medicine, syringe exchange, and HIV/Hep C treatment, testing and other services within our communities.
Southwest Care Center is currently seeking an experienced full-time Referral & Authorization Specialist.We have two positions available with one located at our Harkle Clinic in Santa Fe, NM and the second at our Jefferson Clinic located in Albuquerque NM
Position Details:
Reporting to the Clinic Manager, the Referral and Authorization Specialist is responsible for leading the process for ongoing insurance coverage and benefit verification, obtaining, and maintaining referrals, and completion and submission of prior authorization / pre- determination requests for treatment related services.
This position is further responsible for identifying those insurances that require referral, notification and collaborates with other team members to obtain prior authorizations. In addition, collaborates with referring provider offices that may send patients to SCC.
The R&A specialist will also coordinate care for referrals of SCC patients with outside providers to include the documentation and tracking of results in the EMR in compliance with HRSA requirements and PCMH standards for improving patient experience, outcomes, and safety.
Primary duties and responsibilities include:
- Utilizes effective communication and human relations skills to provide information, education, andsupport to patients and families.
- Obtains required information by interviewing applicants, patients, family members and others asrequired. Accurately completes required documentation.
- Increases program visibility and effectiveness by performing community outreach, participating inassigned community education initiatives, and through collaboration and referrals withcommunity providers and agencies.
- Provides counseling such as nutrition, prevention, and training in the use of medication and treatmentsupplies to assist patients in achieving optimal health and well-being.Identify patients with specific insurances and services that meet the requirement of needing a referral to ensure coordination of care for services not provided directly by SCC.
- Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed.
- Communicate with insurance companies, physicians, specialists, and patients as required to obtain prior authorization/referral.
- Works directly with providers to ensure their requests are being met. Responds to in-house provider questions, requests, and concerns regarding the status of patient referral orders, care coordination or follow-up status.
- Collaborates with other departments as necessary to contribute to efficient workflow.
- Educates patients, staff and providers regarding referral and authorization requirements, payer coverage, eligibility guidelines, documentation requirements, and insurance related changes or trends.
- Maintains knowledge of the following and the associated reference material; Medicare, Medicaid and third-party payer requirements, guidelines and policies, insurance plans requiring pre-authorization and current accepted insurance plans.
- Ensure compliance with relevant regulations, standards and directives from regulatory agencies and third-party payers.
- Participates in staff meetings and attends other meetings and seminars as requested
- Engages with patients, keeping them informed and updated as to the status of the referral.
- Performs other related duties as assigned.
Candidate Highlights:
- Experience: Minimum 2 years working in a healthcare setting in a position such as utilization review, pre-authorization, medical assistant, billing and coding, or other related position where pre-authorization and referrals were primary duties.
- Education: High School Diploma or GEP equivalent. Associate or higher preferred.
- License/Certification: Prior Authorization Certified Specialist (PACS) or Medical Assistant Certification preferred BLS Certificationrequired
Employment Highlights:
- Monday - Friday typical schedule
- Great work/life balance with generous time off plans
- Full benefits package includes medical, dental, vision, 401k with substantial employer contribution, paid time off, professional development programs, and 340B prescription access.
Interested in this Position? Need More Information? Apply today and we will connect you with a member of our recruitment team. We look forward to speaking with you soon.
If you experience difficulty applying or need assistance please contact HR@southwestcare.org.
*Please note, we are unable to respond to resume inquiries.
Living & Working in New Mexico: The Land of Enchantment offers residents a way of life that you won’t find anywhere else in the United States. Our clinic locations are in Santa Fe and Albuquerque, NM. Each with its own unique vibe and both offering all the perks you get when you call New Mexico Home.
- Rich cultural and historical diversity.
- 310 daysof sunshine, combined with a mild, dry climate and four distinct seasons! You’ll forget what humidity is when you live here.
- Unlimited year-round outdoor opportunities including hiking, rock-climbing, rafting, motorized sports, and even skiing. Yes, we have really big ski mountains in and around the deserts of New Mexico!
- Diverse and inclusive communities with amazingly kind people from all walks of life.
- Gorgeous landscapes that include desert and majestic mountains. New Mexico has to be to be seen to believe.
- Continuous festivals, concerts, and events including the internationally known Balloon Fiesta of Albuquerque.
- International airport providing low-cost, quick access in-country and out.
- Big city amenities found in Albuquerque with easy access from Santa Fe (50 min). Many of our employees commute between these cities. Both cities are connected by the NM rail system for those looking for a relaxing commute with a breath-taking view.
- Great schools and family friendly communities.
- And let’s not forget about New Mexican cuisine—it is some of the best food in the country. Will you have red or green?
Southwest Care Center is an equal opportunity employer. We offer equal employment opportunities to employees and applicants without regard to race, color, religion, sex, age,national origin, disability status, protected veteran status, sexual orientation, gender identity, or any other characteristic protected by federal or state law.
Job Details:
Location:
NM Santa Fe - Harkle
Worker Type: Employee
Regular
Scheduled Weekly Hours:
40
