Call & Referral Authorization Coordinator

EvergreenHealth•Kirkland, WA

18d•Onsite

About The Position

Expedites the administrative requirements for patient referral from a primary care provider (PCP) to specialists or specialty services, dealing directly with health plans. Makes decisions and authorizes risk planning referrals, utilizing department and organizational guidelines. Requires daily interaction with patients, staff, healthcare providers, and insurance companies. All job functions are carried out at EvergreenHealth’s scheduling call center.

Requirements

Associate’s degree or equivalent combination of education and experience
3 years of experience in a healthcare insurance or related medical office setting
Working knowledge of ICD9 and CPT codes
Ability to be flexible and relate well with others in a professional and pleasant manner
Knowledge of medical records confidentiality
Excellent communication skills with a high degree of tact and poise to deal effectively with patients, physicians and hospital staff members

Nice To Haves

Medical Terminology, medical billing and computer skills
Working knowledge of insurances, Medicare, DSHS, Labor and Industries, and other third party insurances

Responsibilities

Processes patient referrals from PCP to specialist, working directly with health plans, troubleshooting when necessary.
Serves as a point person coordinating information regarding managed care referrals for patients, providers, case managers and other Utilization Management staff.
Assigns proper ICD-9 and CPT code(s) to patient referrals.
Responsible for communication and dissemination of key managed care contractual information and system processes to patients and staff.
Performs other duties as assigned