Referral/Prior Authorization Coordinator

Referral Coordinator
By working at Harvard University, you join a vibrant community that advances Harvard's world-changing mission in meaningful ways, inspires innovation and collaboration, and builds skills and expertise. Harvard University Health Services (HUHS), part of University Central Administration (CADM), is the on-site multi-specialty medical practice and health administration for the Harvard community. It provides care to students, faculty, staff, eligible post-docs, retirees, and their dependents. HUHS also manages two university-owned health plans, HUGHP and SHIP, and collaborates with other departments to address public health needs.
Serves as liaison between patients and providers to schedule diagnostic tests and specialty consultations at outside organizations (prior authorization as needed) and in-house specialty appointments. Assists patients with tracking referral status in the electronic system. Works collaboratively with Member Services and Care Coordination departments. Office responsibilities include data entry and coordination of mailings. Referral Coordinator Responsibilities
Tracks referral status in the electronic system and ensures documentation of referral visits is available for PCP follow-up or upon request.
Assists patients with scheduling in-house specialty appointments.
Assists patients by providing directions to outside facilities.
Communicates with outside referral services by telephone, fax, and e-mail.
Serves as liaison between patient and inside/outside providers.
Communicates referral appointment information to patient and provider.
Keeps pre-testing instructions updated from referral organizations.
Work collaboratively with Member Services and Care Coordination department.
Enters referral into Blue Cross Provider Central
Initiates process for over 90 days and out of network referral requests in coordination with Member Services.
General Office Responsibilities
As a member of the clinical care team, assures the safe and satisfactory care of patients.
Handles all emergency phone calls appropriately, efficiently, and according to emergency protocol.
Responds appropriately to patient requests for medical record information.
Identifies own learning needs and requests assistance from others when needed.
Documents care provided using appropriate forms.
Demonstrates the ability to identify and respond to potential life threatening situations during telephone encounters.
Demonstrates universal precautions in all care delivery.
Carries out proper procedure for reporting faulty equipment.
Prepares medical records ensuring that confidentiality is maintained.
Works collaboratively with all members of the health care team.
Performs all personal business away from patients and all work areas.
Identifies own learning needs and requests assistance from others when needed.
Adheres to regulatory guidelines i.e. Adheres to departmental and unit specific policies, procedures, guidelines and protocols.
Plans for time off in advance and according to clinic policy.
Is punctual and prepared for duties at start of shift.
Is flexible and responsive to the needs of the clinic and department in regard to work schedule.
Demonstrates caring and willingness to help in all interactions.
Cooperates and complies with goals/projects of clinic and department.
Provides care to the adolescent through utilization of the following:
Provides care to the adult patient through utilization of the following:
Provides care to the geriatric patient through utilization of the following:
Completes and complies with HUHS training requirements including HIPAA Privacy and Security.
High school diploma or equivalent.

Medical secretary/patient service experience.
Typing and/or computer skills, telephone skills, and multi-lingual.
Excellent interpersonal, customer service and organizational skills.
Experience with insurance products and obtaining prior authorization.
Standard Hours/Schedule: 35 hours per week, Monday - Friday
Harvard University's Central Administration (CADM) is a 5,000+ employee organization that supports the university's overall excellence by understanding and serving the needs of its schools, students, faculty, staff, alumni, and surrounding communities. Through dynamic and collaborative partnerships, CADM provides high-quality and efficient services to the schools to help them achieve their goals.
This position has been determined by school or unit leaders that all duties and responsibilities must be performed at a Harvard or Harvard-designated location.