Referral and Authorization Coordinator - AZ - Multispecialty Clinic

Referral and Authorization Coordinator - AZ - Multispecialty Clinic

Midwestern University

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The Referral and Authorization Coordinator for Midwestern University Clinics ensures 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.

• 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 the applicable database.
• Retrieves medical records and critical information from referring providers prior to patient office visits; ensures that all necessary laboratory, imaging test results, and medical records are obtained.
• Informs patients of their referral responsibilities.
• Receives, tracks and obtains insurance authorization from in‑network and out‑of‑network insurance carriers for new patient and follow‑up visits.
• 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.
• Demonstrates a comprehensive understanding of insurance data, benefits, in/out of network issues, notification requirements, pre‑determination services and medical diagnosis to ensure 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; scans documents into the appropriate patient chart.
• Demonstrates knowledge of medical terminology, high proficiency of general medical office procedures including HIPAA regulations.
• Exhibits effective communication, decision‑making and organization skills to ensure efficient job performance.
• Sets daily work priorities to accomplish tasks/goals with minimal direct supervision.
• Handles confidential matters appropriately.
• Communicates with department billing staff in a timely manner to ensure accurate pre‑certification/authorization information is aligned with accurate billing of services.
• Uses sound judgment in involving physicians or other healthcare professionals in the pre‑authorization or denial process.
• Provides high‑level customer service to referring physicians as well as referred patients.
• Provides initial "meet and greet" telephone services to patients and physicians.
• Establishes positive relationships with referring physician offices.
• Assists with operational patient flow as applicable; solves problems.
• 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.
• Verifies patient demographic and additional identifying information appropriately.
• Completes required tasks and database information not completed during intake before forwarding the case.
• Assists patients and staff in verifying insurance benefits to determine the following:
  • Deductibles
  • Co‑pay
  • Benefits/coverage on DME
  • Benefits/coverage on procedures

• High School diploma or GED required and one year college or technical school highly desired.
• 3‑5 years’ experience as a front or back‑office assistant dealing with insurance companies; working knowledge of ICD‑10 and CPT codes; knowledge of different referral provider types in the medical field.
• Knowledge of insurance company criteria for inpatient admission and outpatient diagnostic testing.
• Computer proficiency in MS Office (Word, Excel, Outlook) and Electronic Health Record systems.
• Physical demands: frequently required to stand, walk, use hands to handle or feel, reach with hands and arms, talk and hear; occasionally sit; lift up to 10 pounds frequently; move up to 25 pounds occasionally.
• Regular,…