Clinical Referral Specialist
hace 23 horas
San Diego
Job Description Why work for us? • Balboa Nephrology is the largest kidney care practice in California and participates in a national Medicare program focused on value-based care., • Through our joint venture with Evergreen Nephrology we are a growing organization with opportunities for professional and personal growth., • We will help you grow in your leadership experiences while learning the new value-based care world., • Comprehensive benefits package that includes medical, dental & vision on the 1st of the month 30 days after hire., • Employer contribution of up to 7.5% of annual pay for your 401K., • Generous paid time off plus 8 paid holidays, a birthday float day off and a mental health day!, • Company paid life insurance., • Join a fast-growing field - employment of medical and health services managers is projected to grow 32 percent from 2020 to 2030, much faster than the average for all occupations., • Voted 4 years in a row as a Top Workplace of San Diego 2020-2024! Our Values: Patient-centered I Accountability I Respect I Innovation I Data-Driven Our Mission: to consistently deliver superior care – Balboa Care – to every patient with kidney disease. About the Position The Clinical Referral Specialist is responsible for coordinating outgoing clinical referrals from initiation through completion. This includes ensuring referrals are processed accurately, authorizations are obtained when required, appointments are scheduled, and documentation and results are appropriately recorded in the electronic medical record (Epic). The specialist conducts patient outreach, communicates with specialty providers, and tracks referrals to confirm appointment scheduling, visit completion, and receipt of consult or procedure documentation when applicable. The role serves as a liaison between patients, physicians, clinic staff, and external specialty providers to support timely coordination of care. This position reports to the Director of Central Operations with day-to-day supervision from the Clinical Referrals Supervisor. Background The Clinical Referral Specialist is part of Balboa Nephrology’s Central Operations Department, a centralized team responsible for coordinating key operational workflows that support timely patient access to care across the organization. Central Operations manages high-volume new patient referrals, outgoing clinical referrals, insurance coordination, and dialysis transition planning in close collaboration with physicians, clinic teams, and external specialty partners. This position resides on the Clinical Referrals Team and works across the organization to ensure referrals move efficiently from order to completion while maintaining clear communication with patients and care teams in a fast-paced, highly collaborative environment that prioritizes patient-centeredness, accurate documentation, and efficient coordination of care. Specialists play a critical role in ensuring patients receive the services they need without unnecessary delays while supporting physicians and clinical teams with reliable referral management. Essential Duties and Responsibilities • Process outgoing clinical referrals from initiation through completion using Epic referral workflows., • Prioritize referrals based on urgency and referral type in accordance with established Clinical Referral workflows., • Answer inbound calls from patients, clinic staff, and specialty offices regarding referral status, appointment coordination, and documentation requests., • Processing Clinical Referrals, including, but not limited to:, • Infusions, • Palliative care, • Podiatry, • Biopsies, • Hematology, • Oncology, • Kidney Transplant, • Dialysis Access, • Cardiology, • Nutrition Services, • Psychiatry, • Urology, • Vascular Surgery Access (non-dialysis), • Imaging/Radiology, • Verify insurance coverage and determine whether prior authorization is required., • Submit prior authorization requests with required clinical documentation and track approval status., • Communicate appointment instructions to patients and coordinate referral scheduling when applicable., • Conduct patient outreach through phone calls, voicemail, and secure messaging when patients cannot be reached., • Document all outreach attempts, referral updates, and patient communications accurately in Epic using standardized documentation templates., • Upload referral packets, authorization approvals, consult notes, and supporting documentation into Epic Media Manager., • Transmit referral documentation and authorizations to specialty providers via electronic fax or portal submission when applicable., • Monitor referral work queues and manage referral status updates to ensure timely progression through the referral workflow., • Follow up with patients and specialty providers to confirm appointment scheduling, visit completion, and receipt of consultation notes or procedure documentation when required., • Apply escalation protocols when patients cannot be reached or when clinical urgency requires provider notification., • Close referrals appropriately in Epic once workflow steps and documentation requirements are complete., • Monitor referral-related fax queues and respond to inbound documentation as needed., • Provide ongoing coordination and communication with physicians, medical assistants, clinic teams, dialysis providers, and external specialty partners to support timely referral processing and continuity of patient care., • Support Central Operations activities as needed, which may include assisting the New Patient Referrals and Dialysis Transition teams during high-volume periods., • Perform other duties as assigned. Success Metrics for the Role Performance in this role is measured through a combination of workflow adherence, documentation accuracy, and timely coordination of patient referrals. Key indicators include: • Timely Referral Processing, • Workflow Compliance, • Epic Documentation Accuracy, • Patient Outreach and Communication, • Referral Completion and Close-Out, • Collaboration and Communication Pay Range: $23.00 - $25.00/hour Location: Remote in San Diego, CA Required Qualifications • Minimum 2 years of experience working in a clinical setting with front office responsibilities and patient-facing customer service., • Minimum 1 year of experience using Epic or comparable electronic health record systems., • Proficiency using EHR software applications and electronic referral workflows., • 1 + years of experience processing outbound clinical referrals and obtaining insurance authorizations., • Excellent verbal and written communication skills., • Strong organizational and prioritization skills in a high-volume workflow environment., • Ability to interpret, adapt, and apply operational guidelines and procedures., • Ability to use sound judgment and escalate concerns appropriately., • Ability to establish and maintain effective working relationships with patients, physicians, medical staff, and coworkers., • Strong attention to detail and accuracy in documentation., • Bilingual in English & Spanish Other considerations: • Background check required, • Travel to other sites located within San Diego County may be required, • Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice., • Supervisory duties – No Language Skills While performing duties, the employee is regularly required to talk, hear, read, write, type and respond in English and understand clinical/medical vocabulary written and spoken. Vision Requirements Vision requirements include close vision, ability to adjust focus, and see color. Physical Demands Physical requirements may vary slightly and should be reviewed with your manger. In general, this position requires the ability to lift up to 35 pounds unassisted; ability to stand for extended periods of time and to perform repetitive stooping, walking, stretching, reaching and some sitting; ability to use full range of body motions required to lift patients, wear a lead apron, and lift and move supplies. Must be able to safely ascend and descend stairs as a core part of the job, with or without reasonable accommodation, when no elevator or lift is present. Work Environment Job required tasks routinely involve a potential for mucous membrane or skin contact with blood, body fluids, tissues or potential spills or splashes. Use of appropriate personal protection measures is required for every healthcare provider in these positions. Require to routinely use standard office equipment such as laptop, computer, mouse, and photocopier. About Balboa United Beginning in 1973, Balboa has grown from two physicians to a comprehensive nephrology team of 52 board certified physicians and 8 advanced practitioners. On January 1, 2018, Balboa Nephrology Medical Group (BNMG) launched Balboa United, a full-service medical practice management services organization. From one small office, BNMG now has 24 clinical offices throughout San Diego, Imperial, Orange and Riverside counties. In addition to office and hospital-based patient care, Balboa physicians manage the dialysis treatments of approximately 4,500 patients at 88 dialysis centers and conduct Nephrology based clinical research at 6 centers throughout Imperial and San Diego counties (California Institute of Renal Research). *EEO Statement Balboa United is an equal opportunity employer and makes employment decisions on the basis of merit. We want to have the best available person in every job. Our Company policy prohibits unlawful discrimination based on race, color, creed, religion (including religious dress & grooming), sex (including pregnancy, childbirth or related medical conditions), gender (including gender identity and gender expression), marital status, registered domestic partner status, military status, age, national origin or ancestry, physical or mental disability, medical condition (including cancer and genetic characteristics), genetic information, sexual orientation, or any other basis protected by applicable federal, state, or local law. We also prohibit unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has or is perceived as having any of those characteristics. The Company is committed to compliance with all applicable laws providing equal employment opportunities. This commitment applies to all persons involved in our operations and prohibits unlawful discrimination by any employee of Balboa United, including managers and co-workers. If you believe you have been subjected to any form of unlawful discrimination, submit a written complaint to your manager or Human Resources (HR). Your complaint should be specific and should include the names of the individuals involved and the names of any witnesses. If you need assistance with your complaint, or if you prefer to make a complaint in person, contact the Company's Human Resources Department. We will immediately undertake an effective, thorough, and objective investigation and attempt to resolve the situation.