Overview

Join our team as a PRN (As needed basisl) Assessment & Referral Program Coordinator in Albuquerque, New Mexico.

Fulfilling your purpose begins here:

People First, Always. Here’s how we take care of our people:

• Competitive salaries, support teams and growth opportunities. 

Your team is bigger than your department:

• Lovelace Medical Group is a multispecialty provider group which includes clinics, doctors and advanced practice providers in a broad range of specialties and primary care.
• We believe healthcare is a team sport and every player has something to contribute. We show compassion, celebrate differences and treat one another with respect.

Responsibilities

• Ensures current and standardized referral policies and workflows are followed and utilized on a regular basis.
• Prioritizes referrals by their urgency and addresses them in a timely manner.
• Participates and successfully completes required orientation and training related to job responsibilities.
• Ensures complete demographic, insurance information, and appropriate/pertaining clinical information is sent to referred specialists.
• Contacts insurance companies to ensure prior approval requirements are met. Presents necessary medical information such as history, diagnosis, and prognosis to insurance companies if deemed necessary to prove the medical necessity of services.
• Reviews details and expectations about the referral with ordering providers and patients. Requests new referrals to be ordered when applicable.
• Identifies and utilizes community resources; establishes relationships with servicing providers and personnel.
• Serves as point of contact for patients and specialists for any questions or concerns. Assist in problem-solving potential issues related to their referral due to language or social barriers. If unable to help, assist in finding the right point of contact to further help.
• Receive requests for prior authorization through the electronic health record (EHR) and/or via phone or fax and ensure that they are properly and closely monitored.
• Process referrals and submit medical records to insurance carriers to expedite prior authorization processes.
• Manage correspondence with insurance companies, physicians, specialists, and patients as needed, including documenting in the EHR as appropriate.
• Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed.
• Review the accuracy and completeness of the information requested and ensure that all supporting documents are present.
• Meets departmental goals for referral authorization processing, scheduling, and phone responsibilities.
• Meets individual productivity and accuracy requirements as determined by the Supervisor and/or Manager
• Cooperates and interacts with supervisors, peers, other departments, and all customer groups demonstrating commitment to service.

Qualifications

Job Requirements

• High School Diploma or equivalent 
• Two or more years of experience with Electronic Health Record. 

Preferred Job Requirements 

• Certified Medical Assistant