Referral Coordinator/Prior Authorizations

Job Summary and Responsibilities

The referral coordinator is responsible for implementing, monitoring, and tracking of all aspects of the clinic referral processes. Prior authorizations are tasks within the medical field that are required to provide medications, medical equipment, and diagnostic imaging. Responsibilities for both aspects of this position are listed below.

Referral Coordinator duties include:

• Coordination and tracking of all clinical referrals utilizing the electronic health record.
• Tracking and reporting on all appropriate Patient Centered Medical Home (PCMH) standards as directed. This specifically includes the elements related to tracking referrals, and transition of care.
• Work with designated staff on appropriate clinic related referral processes
• Collaborate with patient and consulting providers to complete referral process
• Provides the highest level of customer service to internal and external clients.
• Other duties as assigned

Prior Authorization duties include:

• Responsible for all aspects of the prior authorization process
• Collecting all the necessary documentation
• Contacting the patient for additional information to ensure completion of the required prior authorization for the prescribed medication, medical equipment and diagnostic imaging
• Interacts with patients, and insurance companies as necessary, to request prior authorizations.
• Provides the highest level of customer service to internal and external clients.
• Other duties as assigned

Requirements/Qualifications/Skills/Experience

Minimum of at least 2 years in primary medical care setting. At least 1 year of experience with referrals preferred. Medical certification or licensure such as CMA, LPN, or RN preferred. Proficiency with electronic health records.