Prior Authorization and Referral Coordinator

Astrana Health, Inc.•Spring Valley, NV

4d•$19 - $23•Onsite

About The Position

The Prior Authorizations and Referral Coordinator is responsible for assisting patients who require specialty care referrals. The coordinator submits all prior authorizations and referrals through the proper insurance portals for approval. Responsible for sending out the referrals to the specialists and following up with the specialists and patents to ensure they are seen.

Requirements

High school diploma or equivalent required
At least 1 year of Call Center Experience
Experience with Medical Terminology
Strong verbal and written communication skills; must be able to communicate in a professional and courteous manner
Proficient in Microsoft Office applications and insurance eligibility database
Excellent data entry and typing skills

Nice To Haves

A minimum of 1-year previous experience for both Prior Authorization and Referrals preferred
Knowledge of E Clinical Works
Knowledge of managed care and medical insurance plans

Responsibilities

Handle incoming calls efficiently.
Responsible for identifying patients’ needs, clarifying information, submitting referrals via insurance portals, faxing out referrals and following up with the patient.
Provide courteous customer service to patients regarding referral requests.
Request consult notes from other providers as needed.
Responds to all patient inquiries concerning their referrals.
Communicate with insurance companies to ensure all requests adhere to guidelines of coverage.
Track referrals and provide follow-up as needed.
Document all referral activities on patient files for future reference.
Maintain accurate and organized patient file documentation.
Process Prior Authorization for Medications, Injections, Biologics.