Referral and Prior Authorization Coordinator - HYBRID

CNY Family Care, LLP•East Syracuse, NY

11d•Hybrid

About The Position

The Referral and Authorization Coordinator is responsible for managing and coordinating all patient referrals within a busy primary care office. This coordinator collaborates closely with clinical staff and providers to ensure that information is accurately documented in the medical record, all insurance-required referrals are obtained, and prior authorizations for advanced medical imaging are secured.

Requirements

High school diploma or general education degree (GED) required
2 years experience working in a health care setting required
Previous experience using electronic medical record (EMR) system required
Must know medical terminology
In Office training 6 - 9 mths and perform all essential job functions before moving to a hybrid schedule

Nice To Haves

one to two years of college preferred
RHIT preferred
Experience in prior authorizations, insurance verification or medical billing helpful
Medent EMR experience candidates highly prioritized

Responsibilities

Responsible for verifying patient insurance benefits, eligibility, and demographic information accurately for corresponding referral.
Communicate with patients, providers, clinical staff, and insurance companies to ensure timely and accurate processing of referrals.
Complete the required unique referral form if required by the specialist for referral and/or ensure the required documentation and orders are accurate and complete.
Ability to read and understand medical terminology and decipher different document types within the Electronic Medical Record (EMR).
Ability to work independently and use critical thinking to problem-solve with minimal supervision; identify gaps in documentation and take corrective actions.
Obtain necessary authorizations and pre-certifications for specialist visits and advanced medical imaging.
Submit, obtain, and track insurance authorizations.
Maintain a detailed record of all referral activities and follow-up actions in the Electronic Medical Record
Responsible for sending the appropriate medical record documentation to the correct insurance carrier via fax or online authorization website.
Responsible for sending the appropriate referral documentation to the correct provider using Electronic Medical Record
Follow up on referrals by generating reports in Medent to ensure timely follow-up per CNY Family Care policies and procedures.
Verify appointments and corresponding documentation is attached to close out referrals.
Contact other physician offices to obtain any missing documentation or consult reports needed.
Utilize local RHIO and Community Chart in Medent to obtain documents from other providers and facilities as needed to close open referrals.
Generate patient correspondence regarding non-compliance with recommended treatment by outside providers/treatment facilities to ensure appropriate follow-through documentation in the patient record.

Benefits

Annual performance review
performance-based merit increase
Health, dental and vision benefits available with coverage effective the first of the month following date of hire
Full complement of voluntary benefits
$1,000 annual employer HSA contribution for employees enrolled in CNYFC high deductible health plan
Free office visits with NP or PA employees who are patients of the practice and enrolled in CNYFC high deductible health plan
Waiver program for health benefits ($3,000 annually)
401K after six months with up to 7% combined employer match and annual discretionary profit-sharing contribution
Generous paid time-off that increases with years of service
8 paid holidays per year
Closed on major holidays
Free onsite parking
Free lunch daily