Referral & Medical Authorization Coordinator

We are more than a health system. We are a belief system. We believe wellness and sickness are both part of a lifelong partnership, and that everyone could use an expert guide. We work hard, care deeply and reach further to help people uncover their own power to be healthy. We inspire hope. We learn, grow, and achieve more – in our careers and in our communities.

Job Description Summary:

This position is responsible for processing referral requests for all providers practicing within the clinic module and ensuring that when needed, referral/authorization numbers are obtained for these services. Access to specialty and ancillary testing services is a key component for the treatment of our patients and the satisfaction of our referring providers. The responsibilities of this position are extremely important in meeting or exceeding customer satisfaction.

Essential Functions:

- Notifies insurance companies of services being rendered, and obtains any necessary authorizations, ensuring notification and verification is complete for each referral
- Obtains and verifies any necessary additional demographic and/or billing information
- Assists in identifying authorization issues and ensures that insurance information has been accurately obtained.
- Works daily queues according to department directives to ensure all payer-specific authorization requirements are met and authorizations successfully obtained while consistently meeting department productivity standards.
- Provides quality customer service to all patients and customers through prompt and courteous professional communication.
- Interfaces with physician practice associates to ensure all necessary documentation is obtained for purposes of pursuing a successful authorization approval.
- Documents accurately into the Electronic Medical Record (EMR) system all actions, interactions, and authorizations surrounding the insurance process for each patient.
- Other duties as assigned

Responsibilities And Duties:

1. 40 % : Search electronic medical records to obtain the required clinical information needed for medical authorization. Provides all necessary information medical records, scripts, et c to payer. 2. 30 % -Reviews, Obtains & Processes all diagnostic/specialty/miscellaneous referral and authorization requests for both provider and facility. 3. 20 % Handles calls from internal and external sources where prioritization and time sensitive action is required. 4. 10 % -Communicates with all involved, payer, provider, patient as appropriate and as per protocol. Provides a standard of excellence as it relates to customer service and satisfaction for all customers.

Minimum Qualifications:

High School or GED (Required)

Additional Job Description:

• Prior experience in obtaining healthcare pre-authorizations
• Working knowledge of ICD-10 and CPT classification systems
• Working knowledge of Anatomy & Physiology, and Medical Terminology
• Experience in a physician practice or hospital setting with patient registration, front desk, and insurance knowledge required
• Experience with third party payors required
• Detailed oriented, self-motivated, a continuous learner with an interest in process improvement, and team player
• Ability to navigate multiple computer screens and browsers quickly and accurately
• Strong communication skills & professional demeanor
• Able to learn and work in a remote work setting while maintaining departmental productivity and accuracy standards

Work Shift:

Day

Scheduled Weekly Hours :

40

Department

Corporate Pre Access

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