Referrals & Authorizations Specialist I

Job Description Summary

The 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

How will you make an impact & Requirements

Collaborates with referring physician offices to ensure referrals are completed appropriately

Ensures that referrals are addressed in a timely manner

Reviews details and expectations about the referral with patients

Communicates effectively about the EMR system

Needs basic knowledge of insurance information (i.e. HMO vs. PPO) classes of insurance and is able to instruct and explain to the patient

Makes outgoing calls to patients to inform them of the preferred in network provider that they are being referred to

Verifies if patient would like assistance in coordinating the appointment

Verifies with patient that all information is attached to request

Coordinates scheduling of appointments when appropriate on behalf of patients with specialist offices

Communicates effectively and professionally with specialist offices

Assists in sending Athena fax request to specialist office

Ensures complete and accurate registration including patient demographic and current insurance information

Assembles information concerning patients clinical background and referral needs. Per referral guidelines provide appropriate clinical information to specialist

Demonstrates the skills of effective communication decision-making and organization to ensure efficient job performance and job success

Daily work is accomplished with minimal direct supervision

Work priorities are set in order to accomplish task/goals

Confidential matters are handled appropriately

Provides high-level customer service to both referring physicians as well as referred patients

Confidentiality of patient data is maintained at all times

Workspace is maintained in an organized and professional manner

Courteous and professional demeanor is demonstrated at all times