PRIMARY FUNCTION

Obtain authorization from insurance companies to assist patients in the referral process. Streamlines administrative requirements for patient referrals.

ESSENTIAL DUTIES AND RESPONSIBILITIES

This list may not include all the duties that may be assigned.

Obtains authorizations for all referral requests received as assigned. Reviews and understands documentation required by insurance companies to obtain authorization, including clinical notes, lab results, and consult notes. Utilizes insurance web portals to obtain authorizations as required. Accurately documents referral details, including status, authorization dates, authorization number, specialist/facility, and other relevant information per policy. Effectively advises updates in referral status with patients, clinicians, and office site staff. Interacts professionally with specialists/facilities and insurance plan representatives. Remains current with company, health plan and specialist requirements. Prioritizes use of preferred specialist/facility within the HER. Meets productivity standards as determined by management team. Manages workloads within notification and request bins in EHR to meet established timeframe expectations. Works collaboratively with department team members to ensure coverage. Manages high priority notifications and requests appropriately. Reviews and updates request pending authorization daily. Communicates and collaborates effectively with Referral Manager and team members. Performs other duties as assigned.

QUALIFICATIONS

EDUCATION:

High School diploma or equivalent.

EXPERIENCE:

One year’s experience in a medical office and/or referral coordinator experience preferred.

KNOWLEDGE, SKILLS, AND ABILITIES

Knowledge of medical terminology, grammar, spelling, and punctuation to type correspondence. Knowledge of the insurance industry. Skills in operating a computer, fax and photocopy machine. Ability to read, understand and follow oral and written instruction. Ability to sort and file materials correctly by alphabetic or numeric systems. Ability to speak clearly and concisely. Ability to establish and maintain effective working relationships with patients, employees, and the public. Typing ability of 40 w.p.m., word processing and computer experience.

 

TYPICAL WORKING CONDITIONS

Working in a professional office environment. May involves high and frequent call volume. Environment requires ability to multi-task, communicate clearly and concisely, data entry for extended periods. May require sitting or standing for long period. May require stooping, bending, and stretching. Requires manual dexterity sufficient to operate a keyboard, type of 40 wmp, and other office equipment. It is necessary to view and type on computer screens for long periods and to work in a high-volume, fast-paced environment. Ability to work remotely may be required.

OTHER PHYSICAL REQUIREMENTS

Vision Sense of sound Sense of touch

PERFORMANCE REQUIREMENTS

Adhere to all organizational information security policies and protect all sensitive information including but not limited to ePHI and PHI (Protected Health Information) in accordance with organizational policy, Federal, State, and local regulations.