Job Description
Job DescriptionJob Summary:Primary function is coordination, processing and scheduling of medical referrals and prior authorizations for a variety of medical or surgical services/procedures for clinic patients, as requested electronically by clinic providers. This requires clinical knowledge and understanding of CPT and ICD (10) codes to meet the requirements of third-party payers and specialty clinics to ensure minimal delay in securing referral appointments or pre-authorizations. As an integral member of the health care Team, manages a high volume of referrals and pre authorizations for multiple Providers in multiple locations, collaborates with other Clinic Referral Specialists, Providers, MA's, Scheduler/Receptionists and other support staff in multiple clinic locations. This position requires the use of clinical and administrative judgment and initiative to determine best approach for both urgent and non-urgent patient care needs.Job Qualifications:To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.General Accountabilities Monitors electronic referral boxes in EMR throughout the day to capture referral requests in real time Prepares and processes all referral and pre authorization paperwork Gathers pertinent information as needed via EMR or from clinical team Contacts various clinics, facilities, companies to obtain information to accurately complete referral/pre authorization requests Utilizes third party payer/insurance portals; has a detailed knowledge of insurance providers, their portals and their expectations for authorization approval Follows all established Lean workflows to meet the highest level of efficiency and timeliness for patients Calls patient within 48 hours of initial referral to provide update Flags Provider and or MA within 48 hours of initial referral to provide update May schedule specialty appointments directly on behalf of patient Utilizes EMR functions to document all pertinent information Organize and prioritizes workload based on acuity Maintains confidentiality by following all applicable HIPAA regulations May be directed to provide clinical care as needed to support care teams during vacation or other absences Performs other related functions requiring a proficiency in communication and organizational skills Maintains specific workflows for specialized tests and/or procedures Is detail oriented and works with a high level of accuracy in every aspect of the job Is a team player who demonstrates an enthusiastic, caring and compassionate commitment to the patient and their unique circumstances Demonstrates outstanding interpersonal skills, time management skills, and an ability to meet or exceed established productivity standards* The company reserves the right to add or change duties at any time. EDUCATION REQUIRED: Minimum education - High school diploma or equivalentEXPERIENCE REQUIRED: Minimum experience - One year in a clinic setting, scheduling, referral or registration in a clinic setting. Knowledge of ICD-10 codes, knowledge of medical terminology, insurance authorization processes for prior authorization. Spanish speaking preferred. Must be detail oriented and well organized.