Bluewater Orthopedics

• Complete and manage referrals for all Bluewater Orthopedics offices and providers.
• Review patient schedules and identify patients who require referrals.
• Request referrals from primary care provider offices when necessary.
• Follow up with primary care offices to obtain pending referrals.
• Verify that referrals are current, valid, and applicable to the patient’s scheduled visit.
• Accurately enter referral information into the appropriate systems and the patient’s chart.
• Attach referrals to the appropriate appointments/orders.
• Monitor outstanding referrals and follow up as needed to prevent delays or missed appointments.
• Maintain referral information in an organized and up-to-date manner.

• Obtain insurance authorizations for services requiring prior authorization.
• Request authorization from primary care offices, insurance companies, or other appropriate entities.
• Complete and submit authorization requests accurately and within required timeframes.
• Monitor pending authorizations and follow up regularly until a determination is received.
• Verify authorization dates, approved services, number of visits/units, and other applicable requirements.
• Accurately document authorization information in the patient’s chart and applicable systems.
• Ensure completed authorizations are attached to the appropriate orders and patient records.

• Complete authorization requests for diagnostic imaging ordered by Bluewater Orthopedics providers.
• Obtain necessary authorization information from insurance companies and/or referring providers.
• Monitor imaging authorization requests through completion.
• Verify that the authorization matches the requested imaging study, body part, facility, and applicable dates.
• Attach completed imaging authorizations to the appropriate orders.
• Distribute imaging orders and authorization information to the designated imaging facility.
• Ensure imaging facilities receive all necessary documentation in a timely manner.
• Follow up on outstanding imaging authorizations to prevent delays in patient care.

• Schedule patients when appropriate based on referral, authorization, and provider requirements.
• Review upcoming schedules to identify missing referrals or authorizations.
• Communicate with patients regarding referral and authorization requirements when necessary.
• Assist with resolving scheduling issues related to referrals, authorizations, and imaging.
• Communicate with providers, clinical staff, primary care offices, insurance companies, and outside facilities as needed.

• Accurately enter patient demographic, insurance, referral, and authorization information.
• Maintain accurate and complete documentation within the electronic medical record and other applicable systems.
• Ensure all referral and authorization information is attached to the correct patient, appointment, order, or encounter.
• Protect patient confidentiality and follow all HIPAA and Bluewater Orthopedics policies and procedures.
• Review work regularly to ensure information is current and accurate.

• Maintain all referral, authorization, and imaging authorization tasks in an organized and current status.
• Review outstanding tasks daily and prioritize items based on upcoming appointments and urgency.
• Ensure no referral or authorization request remains unattended or unnecessarily delayed.
• Follow up proactively with insurance companies, primary care offices, imaging facilities, and other entities.
• Communicate potential delays or issues to management and appropriate clinical staff.
• Maintain accurate records of pending, approved, denied, and completed referrals and authorizations.
• Ensure all assigned responsibilities remain up to date.

Front Desk Support

• Checking patients in and out.
• Verifying and updating patient demographic and insurance information.
• Collecting copays and other applicable patient balances.
• Answering phones and assisting patients with general questions.
• Assisting with scheduling and rescheduling appointments.
• Providing general front desk support to maintain smooth clinic operations.

Qualifications 

• Previous experience in medical referrals, prior authorizations, insurance verification, scheduling, or a medical office environment preferred.
• Knowledge of insurance referral and authorization requirements preferred.
• Experience working with electronic medical records preferred.
• Strong computer and data-entry skills.
• Excellent attention to detail and accuracy.
• Strong organizational and time-management skills.
• Ability to prioritize multiple tasks and meet deadlines.
• Professional and effective communication skills.
• Ability to communicate with patients, insurance companies, primary care offices, imaging facilities, and healthcare providers.
• Ability to work independently while also functioning effectively as part of a team.
• Ability to maintain confidentiality and comply with HIPAA requirements.

Key Performance Expectations

• Keep all referral and authorization tasks current and up to date.
• Proactively identify upcoming appointments requiring referrals or authorizations.
• Minimize delays and prevent avoidable authorization- or referral-related appointment issues.
• Maintain a high level of accuracy when entering patient, insurance, referral, and authorization information.
• Ensure authorizations are properly attached to orders and distributed to the appropriate facility.
• Communicate promptly when an issue may impact patient scheduling or care.
• Provide dependable front desk coverage when needed.
• Maintain professionalism and excellent customer service when communicating with patients and outside healthcare organizations.

• Ability to sit and work at a computer for extended periods.
• Ability to communicate effectively by telephone, email, and in person.
• Ability to manage a fast-paced medical office environment.
• Ability to work across Bluewater Orthopedics locations when required.
• Ability to perform front desk duties and assist with clinic operations when needed.

Position Expectations