referral coordinator II

Job Description Summary

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Job Title: Insurance Referral Authorization Coordinator I

Department: Referrals & Prior Auths

Supervisor: Practice Manager

FLSA Status: Non-Exempt

Prepared By: PK

Prepared Date: 2/22/2019

Approved By: KM

Approved Date: 2/22/19


Job Description: Insurance Referral Authorization Coordinator I

The Insurance Referral Authorization Coordinator I will assure that all referrals are managed effectively and efficiently for all contracted insurances and organizations. It requires the obtaining of referrals utilizing the available tools and resources and effectively documenting and communicating to providers in a timely manner through the EMR system. This job requires the application and interpretation of policies and procedures and the use of independent judgment in a medical setting. The individual must possess the ability to maintain a working knowledge of departmental policies and procedures.


Job Standards:

· Collaborates with referring physician offices to ensure referrals are completed appropriately

· Ensures that referrals are addressed in a timely manner

· Reviews details and expectations about the referral with patients

· Communicates effectively about the EMR system

· Needs basic knowledge of insurance information (i.e. HMO vs. PPO), classes of insurance and is able to instruct and explain to the patient

· Makes outgoing calls to patients to inform them of the preferred in network provider that they are being referred to

· Verifies if patient would like assistance in coordinating the appointment

· Verifies with patient that all information is attached to request

· Coordinates scheduling of appointments when appropriate on behalf of patients with specialist offices

· Communicates effectively and professionally with specialist offices

· Assists in sending Athena fax request to specialist office

· Ensures complete and accurate registration, including patient demographic and current insurance information

· Assembles information concerning patient's clinical background and referral needs. Per referral guidelines, provide appropriate clinical information to specialist

· Demonstrates the skills 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

· Provides high-level customer service to both referring physicians as well as referred patients

· Confidentiality of patient data is maintained at all times

· Workspace is maintained in an organized and professional manner

· Courteous and professional demeanor is demonstrated at all times




Knowledge, Skills & Abilities:

· Excellent written and verbal communication skills with the ability to effectively communicate and establish collaborative relationships with physicians, patients, clinical and administrative staff and the public

· Excellent customer service skills

· Knowledge of clinic office procedures, medical practice and medical terminology

· Ability to recognize, evaluate and solve problems

· Strong organizational skills and attention to detail

· Proficient in the use of end-user computer applications regarding productivity (MS Word, Excel, Outlook), database and patient scheduling and other medical information systems

· Ability to operate various types of office equipment


Qualifications & Requirements:


· High School diploma or equivalent required

· Medical insurance background preferred

· Bilingual – preferred


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Receipt and Acknowledgment:

I acknowledge and understand that:

• Receipt of the job description does not imply nor create a promise of employment, nor an employment contract of any kind, and that my employment is at-will.

• The job description provides a general summary of the position in which I am employed, that the contents of this job description are job requirements and, at this time, I know of no limitations which would prevent me from performing these functions with or without accommodation. I further understand that it is my responsibility to inform my supervisor at any time that I am unable to perform these functions.

• Job duties, tasks, work hours and work requirements may be changed at any time.

• Acceptable job performance includes completion of the job responsibilities as well as compliance with the policies, procedures, rules and regulations of the Home and the Corporation.

• I have read and understand this job description.


Print Employee Name: ______________________________________


Employee Signature: _______________________________________


Date: ________________

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How will you make an impact & Requirements

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Job Standards:

· Collaborates with referring physician offices to ensure referrals are completed appropriately

· Ensures that referrals are addressed in a timely manner

· Reviews details and expectations about the referral with patients

· Communicates effectively about the EMR system

· Needs basic knowledge of insurance information (i.e. HMO vs. PPO), classes of insurance and is able to instruct and explain to the patient

· Makes outgoing calls to patients to inform them of the preferred in network provider that they are being referred to

· Verifies if patient would like assistance in coordinating the appointment

· Verifies with patient that all information is attached to request

· Coordinates scheduling of appointments when appropriate on behalf of patients with specialist offices

· Communicates effectively and professionally with specialist offices

· Assists in sending Athena fax request to specialist office

· Ensures complete and accurate registration, including patient demographic and current insurance information

· Assembles information concerning patient's clinical background and referral needs. Per referral guidelines, provide appropriate clinical information to specialist

· Demonstrates the skills 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

· Provides high-level customer service to both referring physicians as well as referred patients

· Confidentiality of patient data is maintained at all times

· Workspace is maintained in an organized and professional manner

· Courteous and professional demeanor is demonstrated at all times

Knowledge, Skills & Abilities:

· Excellent written and verbal communication skills with the ability to effectively communicate and establish collaborative relationships with physicians, patients, clinical and administrative staff and the public

· Excellent customer service skills

· Knowledge of clinic office procedures, medical practice and medical terminology

· Ability to recognize, evaluate and solve problems

· Strong organizational skills and attention to detail

· Proficient in the use of end-user computer applications regarding productivity (MS Word, Excel, Outlook), database and patient scheduling and other medical information systems

· Ability to operate various types of office equipment

Qualifications & Requirements:

· High School diploma or equivalent required

· Medical insurance background preferred

· Bilingual – preferred

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Compensation Range:

$19.00

to

$28.50

 

The anticipated base salary range represents the Company's good-faith estimate of the compensation it reasonably expects to pay for this position at the time of posting. Actual compensation will be determined based on factors including experience, skills, qualifications, geographic location, internal equity, and business needs.