Authorization & Referral Coordinator II

Authorization & Referral Coordinator II

Job Category: Office & Clerical

Full-Time

Administration 6210 US-290 E Austin, TX 78723, USA

Description

About Austin Regional Clinic:

Austin Regional Clinic has been voted a top Central Texas employer by our employees for over 15 years! We are one of central Texas' largest professional medical groups with 35+ locations and we are continuing to grow. We offer the following benefits to eligible team members: Medical, Dental, Vision, Flexible Spending Accounts, PTO, 401(k), EAP, Life Insurance, Long Term Disability, Tuition Reimbursement, Child Care Assistance, Health & Fitness, Sick Child Care Assistance, Development and more.

Purpose:

Under supervision of the Centralized Authorizations and Referrals Supervisor, is responsible for obtaining authorizations and coordinating the care of patients that are referred to a specialist. Acts as a resource for patients and staff with authorization and/or referral related questions/problems requiring resolution. Carries out all duties while maintaining compliance, confidentiality, and promoting the mission and philosophy of the organization.

Essential Functions:

• Assists with responsibilities and duties of the Referral Coordinator I role as directed by department leadership.
• Maintains current knowledge of insurance authorization and/or referral requirements.
• Obtains authorizations from insurance carriers in a timely and efficient manner as defined in the department guidelines.
• Acts as a resource for patients and staff with authorization and/or referral related questions/problems requiring resolution.
• Communicates authorization and/or referral information to patients and specialist offices in a timely and efficient manner.
• Serves as a liaison between Primary Care and Specialty offices.
• Reviews chart to determine appropriate clinicals to send to insurance as requested.
• Can create, modify and sign referral orders within protocols.
• Responsible for coordinating medical record information for transmission to specialist's office.
• Ensures authorization and/or referral information is properly documented in Epic as outlined in the department guidelines.
• If aware, informs physician of patient compliance with referral plan.
• Informs physicians and management of any issues causing a delay in authorization process.
• Communicates changes and important information to patients and leadership.
• Works efficiently with all departments to promote teamwork within the organization.
• Adheres to all company policies, including but not limited to, OSHA, HIPAA, compliance and Code of Conduct.
• Regular and dependable attendance.
• Follows the core competencies set forth by the Company, which are available for review on CMSweb.
• Works holiday shift(s) as required by Company policy.

Other Duties and Responsibilities:

• Assists with training team members as needed.
• Involvement in organizational development through meeting attendance and committee involvement.
• Responsibilities occasionally may require an adjusted work schedule, overtime, and evening/weekend hours in order to meet deadlines.
• Performs other duties as assigned.

Qualifications:

Education and Experience:

Required: High school diploma or equivalent. Six (6) months or more experience working in the office of a healthcare related facility.

Preferred: Previous experience in insurance authorizations strongly preferred. Previous experience in a high-volume customer service environment and/or experience with contact center phone system a plus.

Knowledge, Skills and Abilities:

• Strong knowledge in business office functions and ability to serve as a resource to staff.
• Knowledge of medical insurance and authorization requirements.
• Knowledge of medical terminology.
• Strong knowledge of procedural and diagnostic coding.
• Strong communication and interpersonal skills.
• Skill with operating PC and using the following software applications: MS Outlook, Word, Excel, and Microsoft Office OneNote.
• Excellent computer and keyboarding skills, including familiarity with Windows.
• Excellent verbal and written communication skills.
• Ability to provide excellent customer service.
• Ability to analyze problems, make decisions, and manage conflict.
• Ability to engage others, listen and adapt response to meet others' needs.
• Ability to align own actions with those of other team members committed to common goals.
• Ability to manage competing priorities.
• Ability to perform job duties in a professional manner at all times.
• Ability to understand, recall, and communicate, factual information.
• Ability to understand, recall, and apply oral and/or written instructions or other information.
• Ability to organize thoughts and ideas into understandable terminology.
• Ability to apply common sense in performing job.

Work Schedule: Monday - Friday 8AM - 5PM. Remote Opportunity once in person training is completed.

Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.