Referrals & Authorizations Specialist I

Job Description Summary

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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

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How will you make an impact & Requirements

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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