"Referral and Authorization Coordinator - AZ - Multispecialty Clinic"

Job Summary

The Referral and Authorization Coordinator for Midwestern University Clinics assures that all referrals are managed effectively and efficiently and provides high-level customer service to both referring physicians as well as referred patients. This position reports directly to the Manager of Patient Accounts at the Multispecialty Clinic.

Essential Duties and Responsibilities

• Assures all referrals are handled effectively and efficiently.
• Collaborates with referring physician offices to ensure referral forms are completed appropriately.
• Enters necessary referral and authorization information into applicable database.
• Retrieves medical records and critical information from referring provider(s) prior to patient office visits; ensures that all necessary laboratory, imaging test results, and medical records are obtained.
• Informs the patients of their referral responsibilities.
• Receive, track and obtain insurance authorization from in-network and out-of-network insurance carriers for New Patient and Follow-up visits with our medical providers.
• Analyze information required to complete pre-authorizations with insurance carriers and service area contacts.
• Pre-authorization services are understood and integrated in an applicable database.
• Comprehension of insurance data, benefits, in/out of network issues, notification requirements, pre-determination services and medical diagnosis is consistently demonstrated to ensure that all pre-authorizations are completed prior to the date of service.
• Accurately enters notes into the EHR system regarding letters or correspondence from insurance companies regarding insurance authorization or other notifications. These documents should also be scanned into the appropriate patients chart.
• Demonstrate and apply knowledge of medical terminology, high proficiency of general medical office procedures including HIPAA regulations.
• Demonstrates the skill of effective communication, decision-making and organization to ensure efficient job performance and job success.
• Daily work priorities are set to accomplish tasks/goals with minimal direct supervision.
• Confidential matters are handled appropriately.
• Communication with department billing staff is accomplished in a timely manner to ensure accurate pre-certification/authorization information is aligned with accurate billing of services.
• Sound judgment is consistently demonstrated as to when to involve physician or other health care professions in the pre-authorization or denial process.
• Provides high-level customer service to both referring physicians as well as referred patients.
• Provides initial “meet and greet” services over telephone to patients and physicians.
• Establishes positive relationships with referring physician offices.
• Assists with operational patient flow as applicable; performs problem solving.
• Directs and assists patients, families, and staff in accessing appropriate resources.
• Develops tools to assess patient referral processes with respect to efficiency and customer service.
• Maintains current working knowledge; adheres to MSC and departmental policies and procedures.
• Patient demographic and additional identifying information are verified appropriately.
• Required tasks and database information, not completed during intake are accurately completed prior to forwarding case.
• Assist patients and staff in verifying insurance benefits to determine the following:
  • Deductibles
  • Co-pay
  • Benefits/coverage on DME
  • Benefits/coverage on procedures

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. This individual must have the ability to work in a constant state of alertness and safe manner and must have regular, predictable, in-person attendance. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience

High School diploma or General Education Degree (GED) required and one year college or technical school highly desired. Must have 3-5 years’ experience as front or back-office assistant dealing with insurance companies; working knowledge of ICD-10 and CPT codes; must have knowledge of different referral provider types in the medical field. Knowledge of insurance company criteria for inpatient admission, and outpatient diagnostic testing is current.

Computer Skills

Computer proficiency in MS Office (Word, Excel, Outlook). Proficiency in Electronic Health Record systems.

Physical Demands

While performing the duties of this Job, the employee is frequently required to stand, walk, use hands to handle or feel, reach with hands and arms, talk and hear. The employee is occasionally required to sit. The employee must frequently lift and /or move up to 10 pounds and occasionally life and/or move up to 25 pounds.

About the Employer

Midwestern University is a private, not-for-profit organization that provides graduate and post-graduate education in the health sciences. The University has two campuses, one in Downers Grove, Illinois and the other in Glendale, Arizona.