Referral Specialist - Primary Care - Daytona

Top reasons to work for SMA Healthcare:

• Career growth and advancement potential
• Great benefits such as: Health, Dental, Vision, Life, & Disability Insurance
• Tuition Reimbursement
• Paid Personal Leave and Paid Holidays
• 403b Retirement Plan (matches one to one of employee contribution for the first 3%, then a 50% match on the next 6% of employee contribution)

Essential Job Functions:

• Complete calls from individuals inquiring about referrals, ordering of durable medical equipment, and prior authorizations.
• Requires the ability to perform independent analysis and problem solve.
• Provide back-up to front desk and medical staffing for inbound calls.
• Responds to imaging centers, specialists' office and doctors' office in regard to requests for medical records.
• Responds to requests from hospital emergency departments in regard to referrals that are STAT.
• Notify providers and patients of placement of referrals and keep medical records up to date with proper documentation.
• Knowledge of CPT codes and ICD 10 codes.
• Makes commitment to SMA's mission and core values the SMA Way
• Abides by principles of EEO compliance and a workplace of dignity and respect.
• Works cooperatively in a group/team setting.
• Shows respect to others.
• Takes guidance and direction from supervisors.
• Arrives/Reports to work on time and ready to work.

Qualification Requirements: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Minimum Education and/or Experience: At Minimum a High school Diploma and 2 years of direct care experience working in the Human services or related field. Graduation from an accredited school with a associate's degree in human services or a related field. Experience with Medicare, Medicaid, private insurances, ICD 10 codes and CPT codes is preferred.

Knowledge/Skills/and Abilities: 

• Proficiency in working with telephone system and telephone etiquette.
• Knowledge of ICD 10 and CPT codes.
• Knowledge of Medicare, Medicaid and private insurances.
• Knowledge of prior authorizations such as medication, imaging and specialty providers.
• Proficiency in working with computer hardware and software, when assigned.

Necessary Special Requirements Possession of a valid Florida driver's license and acceptable  driving record if required to drive SMA vehicle and/or use personal vehicle for SMA business. Proof of personal automobile insurance if the position requires you to drive your own vehicle for SMA business (does not include incidental use). Complete State of Florida mandatory level  2 background screening prior to start of employment if direct contact with children/adolescents,  vulnerable adults, or the developmentally disabled may be involved.  Complete Mandt, CPR, First Aid and HIV/AIDS training during the first six (6) months of employment and updated if required.

Physical: Mobility and ability to bend and reach during an 8-12 hour day. Able to lift minimum 10 pounds. Visual and auditory acuity sufficient to evaluate, intervene, treat, and record client health care needs. Fine motor skills for legible and accurate charting, daily correspondence and presentation, either manually or orally. Ability to speak clearly and audibly to communicate review finding to clinical staff and managed care reviewers, and to train staff in principles of UM. Work endurance ability to work 8-12 hour shifts with a meal break, as possible. Routine 8-12 hour shifts. Hours and days off may vary. Extra hours, including weekends and holidays, may be required.  May require travel to other SMA locations. May require extended hours or overnight shifts during  a natural disaster such as a hurricane.  May require travel to other SMA locations.

Application: This class specification is intended to identify the class and illustrate the kinds of duties that may be assigned to its incumbents.  It should not be interpreted as describing all of the duties whose performance may ever be required of such an employee or be used to limit the nature and extent of assignments such individuals may be given.