Authorizations & Referral Coordinator

POSITION SUMMARY

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.

QUALIFICATIONS

Qualifications include:

• 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

Minimum Qualifications

• 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

Preferred Qualifications

• More than 3 years of direct experience and proficiency in authorizations, eligibility, and benefits in a medical office setting
• Bilingual is a plus.