Authorization Coordinator

Reports to: Director of Rural Health Clinic Department: Rural Health Clinic JOB SUMMARY The Authorization Coordinator performs an essential role in the Campbell Clinic by assisting medical staff in obtaining authorizations for medications, procedures, durable medical equipment, referrals, and any other medical services required by insurance in an ongoing effort to further the continuity of care for all clinic patients. This position requires contact with patients, vendors, clinic staff, and other medical professionals. ESSENTIAL FUNCTIONS Receives requests for authorizations through the electronic health record (EHR) and/or via phone, fax, or in person and ensures that they are properly monitored in a timely manner. Processes authorizations and submits medical records to insurance carriers to expedite prior authorization processes. Manage correspondence with insurance companies, healthcare providers, specialists, and patients as needed, including documenting in the EHR as required. Assist healthcare providers with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed. Review the accuracy and completeness of information requested and ensure that all supporting documents are present. Review denials and follow-up with healthcare providers to obtain medically necessary information to submit an appeal of the denial. Prioritize incoming authorization requests by level of urgency to the patient. Maintain positive communications between Campbell Clinic and outside facilities, providers, and insurance carriers. Develop and foster relationships with patients to ensure them of Campbell Clinic's commitment to continuity of care. Respond regularly and timely to voicemails/emails that pertain to patient authorizations and/or referrals from patients, healthcare providers, pharmacies, insurance companies, and any other outside facilities as required. Communicate with patients concerning updates on authorizations and referrals on a regular basis and in a timely manner. Coordinate with the referral coordinator to ensure all authorizations and referral requests are processed in a timely manner. ADDITIONAL RESPONSIBILITIES Covers shifts for other support staff on an as needed basis including referral coordinator, patient care techs, and receptionist/operator. Other duties as assigned. KNOWLEDGE, SKILLS AND ABILITIES Must possess good people skills and customer service skills Very attentive to details. It takes time to understand the reasons for authorizations and referrals, type of authorizations and provider needed, and insurance requirements Strong command of the English language, both written and oral Exhibits high ethical and professional standards Appropriate understanding of computer hardware (i.e. PCs, tablets, laptops) and software (i.e. Microsoft Office, email, internet, HER) Ability to "multi-task" in a high demand daily schedule Medical terminology and knowledge of common medication names is beneficial and recommended EDUATION AND EXPERIENCE High school graduate or equivalent, required Medical assistant certification or higher, required One (1) year primary care experience, preferred One (1) year medical authorization/referral experience, preferred #J-18808-Ljbffr