Referral and Authorization Coordinator, Access, (Novato), Full-Time, Days

MarinHealth•Novato, CA

1d•Onsite

About The Position

MarinHealth is an integrated, independent healthcare system with deep roots throughout the North Bay, comprising MarinHealth Medical Center (a 327-bed hospital in Greenbrae) and 55 primary care and specialty clinics in Marin, Sonoma, and Napa Counties. Affiliated with UCSF Health, MarinHealth is recognized for its pioneering medicine and personalized care, having earned accolades such as being named one of the Top 250 Hospitals Nationwide by Healthgrades and receiving a 5-star Ranking for Overall Hospital Quality from the Centers for Medicare and Medicaid Services. The Referral and Authorizations Coordinator provides medical administration support to providers by obtaining referral or prior authorizations for patients to see specialty providers. This role serves as a resource to providers, clinic leaders, and the Patient Access Department regarding the referral and authorization process.

Requirements

High school diploma or General Educational Development (GED) certificate.
Medical terminology, Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS)/International Classification of Diseases (ICD)-9 coding knowledge.
Knowledge of medical terminology/anatomy.
Ability to exercise discretion and make independent judgements, seeking review when decisions represent significant departure from established guidelines.
Knowledge of Microsoft Office programs including Excel, Word or similar programs.
Ability to maintain composure during challenging interpersonal interactions.
Interpersonal skills and telephone communication.
Organizational skills with attention to detail and follow-up.
General knowledge of patient access, financial counseling, and ambulatory settings.
Working knowledge and understanding of insurance and medical terminology.
Emergency Medical Treatment and Active Labor Act (EMTALA) and Consent Laws knowledge.
Time management skills and the ability to manage frequent in-person patient contacts while effective maintaining and documenting data in the patient registration systems.
Demonstrated ability to work in multiple computer systems, such as patient registration/accounting systems, telephone consoles, document imaging, scanning, payment posting, proprietary payer websites and data quality monitoring, both accurately and efficiently.
Verbal and written communication skills.
Accuracy and attentiveness to detail.
Decision making and problem-solving skills.
Ability to work concurrently on a variety of tasks/projects in diverse environment.
Ability to meet or exceed targeted customer service, productivity and quality standards.
Computer proficiency skills.
Ability to work with and maintain confidential information.

Nice To Haves

2 years of experience working in a health care setting
2 years of experience working with insurance prior authorizations, referrals and working with electronic health record
Epic and/or APeX experience

Responsibilities

Accurately processes referrals requests and obtains necessary authorizations in compliance with Referral Management Program.
Closely collaborates with physician office staff to ensure accuracy, timely handling, and appropriate scheduling of referral appointments within the correct departments.
Maintains positive working relationships with payer representatives including Managed Care, processes authorization and referral requests for members in coordination with health plans and contracted providers.
Utilizes critical thinking and attention to detail to communicate with patients in their preferred method through either online secure messaging, telephone, or in writing throughout the referral process to ensure that services are rendered.
Complies with HIPAA and confidentiality policies and procedures.
Supports completion of work queue items; referral processing, registration and insurance verification activities.
Establishes & maintains a collaborative working relationship with providers & Patient Access staff to ensure smooth record flow and the provision of high-quality services at all times.
Arranges and maintain medical records to ensure proper order and easy retrieval, and maintain confidentiality and security of records.
Supports HIM as necessary to scan documentations of lab results, hospitalizations and discharge forms, and other documents pertaining to the patient or requested appointment.
Ensures that all work meets quality standards and is completed in a timely manner.
Perform other duties as assigned.
Supports the implementation of programs, policies, initiatives, and tools.
Contributes ideas and actions towards the continuous improvement of Patient Access related processes within area of influence.
Seeks and responds to regular performance feedback from team lead; provides upward feedback as needed.
Maintains positive work relationships with members of other teams to communicate effectively and to ensure compliance with cross-team responsibilities.
Assists in ensuring efforts of the team to support building strong peer-to-peer relationships.
Performs revenue cycle tasks necessary to ensure compliance and exceptional customer service.
Authenticates patient identity throughout all processes.
May provide directional support to patients and/or family members.
Maintains knowledge of applicable Federal, State, and local laws and regulations, C.A.R.E.S. as well as MarinHealth policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior.