Referral & Authorization Coordinator - Hybrid

University Physician Group•Detroit, MI

19h•Hybrid

About The Position

The Referral and Authorization Coordinator position serves to provide integrated services essential to care delivery and revenue. The R&A coordinator is responsible for obtaining pre-certifications and pre-authorizations for procedures, specialist referral appointments; scheduling for outpatient testing with other providers for Wayne Health. Coordinates processes, documents medical referrals and prior authorizations for a variety of medical services for clinic patients, as requested electronically by clinic providers. They provide excellent customer service when answering incoming calls from patients and the public, schedule appointments, make follow-up phone calls, address complaints, troubleshoot problems and provide information to patients and public. The Referral and Authorization Coordinator role demonstrates a commitment to a patient-centric, efficient health care delivery system that focuses on quality, safety and operational excellence.

Requirements

High School Diploma or equivalent required.
Minimum 2-3 years insurance, medical prior authorization, billing or Physician Office experience.
Working knowledge of ICD10 and CPT Codes
Able to operate and stay organized when using multiple computer screens and website windows
Proficiency in Microsoft Outlook, Teams, Word and Excel
Intermediate medical terminology
Basic office skills including typing 35 wpm and accurately enter alpha numeric data
Possess excellent verbal, written communication and problem-solving skills
Excellent interpersonal skills necessary to establish and maintain productive working relationships with physicians, patients and their families and other people both inside and outside the clinical practice area
Excellent customer service skills including the ability to use independent thinking, sound judgement and creativity when resolving customer issues or concerns
Attention to detail in documentation and communication
Ability to effectively work independently and with a team
Manage multiple tasks with shifting priorities.
Knowledge of medical insurance and medical office billing
Requires sensitivity to work with seriously ill patients and their families
Compliance with Department Health and Safety policies and procedures

Nice To Haves

Proficient in navigating EHR, Nextgen or Athena system preferred
Ability to stand/sit for long periods of times and lift up to 50 pounds

Responsibilities

Process referrals and submit medical records to insurance carriers to expedited prior authorization process
Contact insurance carriers to verify patient’s insurance eligibility, benefits and requirments
Schedule appointments for imaging and diagnostic services
Schedule appointments for new and returning patients.
Request, track and obtain pre-authorization from insurance carriers within time alloted for medical and services.
Document and communicate patient correspondence/messages accurately to the appropriate personnel/providers.
Manage all incoming referral repositories: EHR buckets, provider email, faxes, Auth inbox, Teams message groups and document all communication in electronic medical record.
Request, follow-up and secure prior-authorizations prior to services ordered
Regularly calls insurance companies to follow-up on authorizations
Applies detail knowledge of ICD10 and CPT codes
Achieve individual productivity and quality metrics set by management
Manage correspondence with insurance companies, physicians, specialist and patients as needed, including documenting in the EMR.
Review accuracy and completeness of information requested and ensure that all supporting documents are present
Prioritize the incoming authorizations by level of urgency to the patient
Provide excellent customer service, anticipates and respond to needs of others in a courteous timely manner, treat others with care and respect.
Maintain excellent interpersonal skills necessary to establish and promote productive working relationships with physicians, patients and their families and other individuals both inside and outside the clinical practice area.
Updates patient insurance, email, phone and all demographics as needed for each patient serviced in EHR.
Monitor insurance changes relative to coverage, authorization requirments
Support/perform activities related to appeals of any denied authorization
Answer Wayne Health calls.
Schedule appointments for new and returning patients.
Update patient information and patient registration.
Responds to patient/customer inquiries both over the phone and by email.
Research required information using available resources.
Respond to and resolve patient complaints.
Process referral requests.
Identify and escalate urgent and emergent patient questions.
Route calls to appropriate resources when unable to resolve the complaint/concern directly.
Follow up with patients and callers within predefined timeframes set by departments.
Clearly document all communications and contacts with providers and personnel in standarized documentation requirements according to standard operating procedures.
Exercise sound judgement and decision-making skills.
Communicate clearly, take initiative and is flexible.
Exhibit good interpersonal communications skills.
Convey a positive and professional image to the patients and the public.
Work well under pressure.
Contribute to the team effort.