Medical WO - Referrals Coordinator

Thundermist's Mission - To improve the health of our patients and communities by delivering exceptional health care, removing barriers to that care, and advancing healthy lifestyles.


Please note, effective September 1,2021, all Thundermist employees are required to have an initial dose of vaccine to prevent Covid-19. Effective October 1, 2021, all employees of RI licensed health care facilities must be fully vaccinated against Covid-19. Employees may be deemed exempt from this requirement based on documentation from their health care provider.


General Responsibilities:

The Referral-Prior Authorization Coordinator performs all functions necessary to process, obtain, and close referrals and prior authorizations in an accurate and timely manner. The coordinator will complete all documentation/forms and communicate information accurately to external providers/entities to ensure a high-quality patient experience. The coordinator will also maintain accurate records and update providers and patients as needed throughout the process.

Required Qualifications:

Minimum High School diploma or GED Excellent communication skills

Preferred Qualifications:
Bi-lingual desired

Post-secondary training in Medical Assistant Program/Professional School preferred 1-year experience working with prior authorizations/referrals preferred

Candidates who do not meet all the preferred qualifications are encouraged to

Process urgent and routine referrals/prior authorizations within expected timeframes

Meet with patients to schedule appointments, confirm preferred facility/specialist, update insurance, and assist with referral/prior authorization questions including providing proper documentation to patient

Advise patients of referral/prior authorization process and timeline Recognize and utilize the preferred processes for specialists
Act as a liaison with pharmacies, insurers, and rendering facilities

Timely outreach to specialist offices/other to obtain consult notes following patient visits to close out pending referrals

Documentation in patient record regarding appointment date, consult note status, and prior authorization status updates

Monitor all referral/prior authorization queues, perform patient outreach, and identify barriers to bring referral/prior authorization to completion

Perform and clearly document appropriate patient outreach and action taken to ensure timely completion of referral/prior authorization
Responds by the end of the business day to incoming telephone encounters and voicemail queue in order to provide updates and bring issues to resolution

Clearly and concisely document actions taken in patient record

Provide patient with referral/prior authorization coordinator contact information to further assist with questions and/or the referral process

Outreach to specialist offices to inquire about services, determine wait times for visits, and to determine referral policies

Ensure that patient clearly understands the process, expectations, and timeline of the office to which they are being referred

Obtain required documents (i.e., labs, DI, progress notes, etc.,) from EMR for attachment to prior to sending

Able to obtain required records (i.e., consult notes, DI, labs, etc.) from external resources utilizing (i.e.,

Cerner, Life Links, Landmark, Current Care, etc.) electronic and other resources to attach to referral Create, update, and/or change referral/prior authorization at provider request

Obtains insurance referral and notes authorization number, dates, and total # of visits allowed prior to sending referral

Fax clinical notes to insurer when prior authorizations are initiated for patients from another facility

Monitor’s queues for prior authorization approval letters then faxes or calls rendering facility, pharmacy, and/or patient with approval information

Monitor faxes for pharmacy denials and reviews patient records and/or contacts patient to verify list of failed medications, checks plan formulary, confers with THC pharmacist or pharmacy for alternatives for provider approval/denial

Inform provider/prescriber of denials to determine if an appeal should be submitted and submit appeal if determined appropriate with all accompanying documentation

Prepares responses to authorization denials within an appropriate timeframe Monitor eCW to verify fax confirmations; resend failed faxes

Research provider information (NPI, address, phone/fax) and CPT codes for out of network for medical prior authorization requests

For patients with Medicare Part D, contact plan or pharmacy to verify the correct plan and ID number Closes duplicates and completes process in an open request

Follows standardized workflows to enable continui