referral coordinator II

Job Description SummaryJob Title: Insurance Referral Authorization Coordinator IDepartment: Referrals & Prior AuthsSupervisor: Practice ManagerFLSA Status: Non-ExemptPrepared By: PKPrepared Date: 2/22/2019Approved By: KMApproved Date: 2/22/19Job Description: Insurance Referral Authorization Coordinator IThe 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 appropriatelyEnsures that referrals are addressed in a timely mannerReviews details and expectations about the referral with patientsCommunicates effectively about the EMR systemNeeds basic knowledge of insurance information (i.e. HMO vs. PPO), classes of insurance and is able to instruct and explain to the patientMakes outgoing calls to patients to inform them of the preferred in network provider that they are being referred toVerifies if patient would like assistance in coordinating the appointmentVerifies with patient that all information is attached to requestCoordinates scheduling of appointments when appropriate on behalf of patients with specialist officesCommunicates effectively and professionally with specialist officesAssists in sending Athena fax request to specialist officeEnsures complete and accurate registration, including patient demographic and current insurance informationAssembles information concerning patient's clinical background and referral needs. Per referral guidelines, provide appropriate clinical information to specialistDemonstrates the skills of effective communication, decision-making and organization to ensure efficient job performance and job successDaily work is accomplished with minimal direct supervisionWork priorities are set in order to accomplish task/goalsConfidential matters are handled appropriatelyProvides high-level customer service to both referring physicians as well as referred patientsConfidentiality of patient data is maintained at all timesWorkspace is maintained in an organized and professional mannerCourteous and professional demeanor is demonstrated at all timesKnowledge, 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 publicExcellent customer service skillsKnowledge of clinic office procedures, medical practice and medical terminologyAbility to recognize, evaluate and solve problemsStrong organizational skills and attention to detailProficient in the use of end-user computer applications regarding productivity (MS Word, Excel, Outlook), database and patient scheduling and other medical information systemsAbility to operate various types of office equipmentQualifications & Requirements:High School diploma or equivalent requiredMedical insurance background preferredBilingual – preferred-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: ________________How will you make an impact & RequirementsJob Standards:Collaborates with referring physician offices to ensure referrals are completed appropriatelyEnsures that referrals are addressed in a timely mannerReviews details and expectations about the referral with patientsCommunicates effectively about the EMR systemNeeds basic knowledge of insurance information (i.e. HMO vs. PPO), classes of insurance and is able to instruct and explain to the patientMakes outgoing calls to patients to inform them of the preferred in network provider that they are being referred toVerifies if patient would like assistance in coordinating the appointmentVerifies with patient that all information is attached to requestCoordinates scheduling of appointments when appropriate on behalf of patients with specialist officesCommunicates effectively and professionally with specialist officesAssists in sending Athena fax request to specialist officeEnsures complete and accurate registration, including patient demographic and current insurance informationAssembles information concerning patient's clinical background and referral needs. Per referral guidelines, provide appropriate clinical information to specialistDemonstrates the skills of effective communication, decision-making and organization to ensure efficient job performance and job successDaily work is accomplished with minimal direct supervisionWork priorities are set in order to accomplish task/goalsConfidential matters are handled appropriatelyProvides high-level customer service to both referring physicians as well as referred patientsConfidentiality of patient data is maintained at all timesWorkspace is maintained in an organized and professional mannerCourteous and professional demeanor is demonstrated at all timesKnowledge, 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 publicExcellent customer service skillsKnowledge of clinic office procedures, medical practice and medical terminologyAbility to recognize, evaluate and solve problemsStrong organizational skills and attention to detailProficient in the use of end-user computer applications regarding productivity (MS Word, Excel, Outlook), database and patient scheduling and other medical information systemsAbility to operate various types of office equipmentQualifications & Requirements:High School diploma or equivalent requiredMedical insurance background preferredBilingual – preferredCompensation Range:$19.00to$28.50The 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. #J-18808-Ljbffr