The Referral and Authorization Coordinator at the Multispecialty Clinic 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 RESPONISBILITIES:
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.
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 in to the appropriate patients chart.
Demonstrate and apply knowledge of medical terminology, high proficiency of general medical office procedures including HIPAA regulations.
Analyzes information required to complete pre-authorizations with insurance carriers and service area contacts.
Pre-authorization services are understood and integrated in an applicable database.
Knowledge of insurance company criteria for inpatient admission, and outpatient diagnostic testing is current.
Demonstrates the skill of effective communication, decision-making and organization to ensure efficient job performance and job success.
Daily work is accomplished with minimal direct supervision.
Work priorities are set in order to accomplish task/goals
Confidential matters are handled appropriately.
Familiarity with current ICD-10 and CPT codes is demonstrated.
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.
Comprehension of insurance data, benefits, in/out of network issues, notification requirements, pre-determination services and medical diagnosis is consistently demonstrated in order to ensure that all pre-authorizations are completed prior to the date of service.
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:
Benefits/coverage on DME
Benefits/coverage on procedures
This job has no supervisory responsibilities
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 and ICD-10 coding; must have knowledge of different referral provider types in the medical field. Experience with CPT, HCPCS, and insurance eligibility preferred.
Computer proficiency in MS Office (Word, Excel, Outlook) Proficiency in Allscripts EHR and PM preferred.
Intermediate skills: Ability to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of organization.
Intermediate skills: Ability to apply common sense understanding to carry out instructions furnished in written, oral or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.
Basic skills: Ability to add, subtract, multiply, and divide all units of measure using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to interpret bar graphs.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
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.
Midwestern University is an Equal Opportunity/Affirmative Action employer that does not discriminate against an employee or applicant based upon race; color; religion; creed; national origin or ancestry; ethnicity; sex (including pregnancy); gender (including gender expressions, gender identity; and sexual orientation); marital status; age; disability; citizenship; past, current, or prospective service in the uniformed services; genetic information; or any other protected class, in accord with all federal, state and local laws, including 41 C.F.R. 60-1.4(a), 250.5(a), 300.5(a) and 741.5(a). Midwestern University complies with the Smoke-Free Arizona Act (A.R.S. 36-601.01) and the Smoke
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