Authorizations & Referral Coordinator
Position: Authorizations / Referral Coordinator
Our mission is to provide exceptional quality and compassionate musculoskeletal care to our community. The Authorization and Referral Coordinator courteously interacts with all patients, referral sources and insurance plans while ensuring all specific insurance referral and authorization requirements are met. Ensures all practice policies and department workflows are followed and timely and courtesy responds to all inquiries and act as liaisons between the practice and the community.
DUTIES AND RESPONSIBILITIES
- Answers phone in prompt, courteous and helpful manner, screening, and routing calls as needed, creates phone note in the patient electronic medical record, and/or provides information to patients.
- Registers patients in EMR as applicable
- Confirms patient demographics and paperwork for accuracy, completions, and missing information
- Verifies insurance eligibility and benefits in accordance with patient insurance coverage for all patient office encounters and referral orders.
- Ensures proper clinical chart documentation present for all patient office encounters and for all Referral Orders
- Obtains prior authorization and/or referrals in accordance with patient insurance coverage for all patient office encounters and referral orders prior to services being rendered
- Accurately calculates any estimated patient out of pocket costs for services, communicates all out-of-pocket costs to patient and collects prior to services being rendered
- Documents the authorization status in proper manner in all applicable areas of EMR.
- Builds accurate Case Management in EMR as indicated
- Attaches appropriate Case Management to appointment as indicated
- Notifies all applicable staff as to status/completion of above processes
- Courteously interacts with patients, family members, visitors, and members of the health care team; directs patient questions and/or concerns to appropriate department; keeps patients informed of auth/referral status.
- Schedules patients for follow-up office visits or procedures, logs no-show appointments; assist in indexing all Document Management images as indicated.
- Assists with proper routing of incoming faxes and documents.
- Maintains medical records in accordance with practice policies and procedures.
- All other duties as assigned.
- Excellent customer / patient service
- Knowledge of medical terminology
- Working knowledge of computer programs
- Excellent written and verbal communication skills
- Understand/Perform training on practice management software
- Ability to promote favorable facility image with physicians, patients, insurance companies, and general public
- Ability to communicate effectively on the telephone
- Ability to make decisions and solve problems
- Working knowledge of health insurance plans including reading plan requirements
- Follow all Standard Operating Procedures
- High School diploma or GED
- 3 - 5 years medical front office, billing, or other administrative experience; and
- Proficiency in authorizations, eligibility, and benefits in a medical office setting
- More than 3 years of direct experience and proficiency in authorizations, eligibility, and benefits in a medical office setting
- Bilingual is a plus.