Referrals & Authorizations Specialist I

Millennium Physician Group•Zephyrhills, FL

About The Position

The Insurance Referral Authorization Coordinator I will assure that all referrals are managed effectively and efficiently for all contracted insurances and organizations. It requires the obtaining of referrals utilizing the available tools and resources and effectively documenting and communicating to providers in a timely manner through the EMR system. This job requires the application and interpretation of policies and procedures and the use of independent judgment in a medical setting. The individual must possess the ability to maintain a working knowledge of departmental policies and procedures.

Requirements

Needs basic knowledge of insurance information (i.e. HMO vs. PPO), classes of insurance and is able to instruct and explain to the patient

Nice To Haves

Ability to maintain a working knowledge of departmental policies and procedures

Responsibilities

Collaborates with referring physician offices to ensure referrals are completed appropriately
Ensures that referrals are addressed in a timely manner
Reviews details and expectations about the referral with patients
Communicates effectively about the EMR system
Makes outgoing calls to patients to inform them of the preferred in network provider that they are being referred to
Verifies if patient would like assistance in coordinating the appointment
Verifies with patient that all information is attached to request
Coordinates scheduling of appointments when appropriate on behalf of patients with specialist offices
Communicates effectively and professionally with specialist offices
Assists in sending Athena fax request to specialist office
Ensures complete and accurate registration, including patient demographic and current insurance information
Assembles information concerning patient's clinical background and referral needs.
Per referral guidelines, provide appropriate clinical information to specialist
Demonstrates the skills of effective communication, decision-making and organization to ensure efficient job performance and job success
Daily work is accomplished with minimal direct supervision
Work priorities are set in order to accomplish task/goals
Confidential matters are handled appropriately
Provides high-level customer service to both referring physicians as well as referred patients
Confidentiality of patient data is maintained at all times
Workspace is maintained in an organized and professional manner
Courteous and professional demeanor is demonstrated at all times