POSITION SUMMARY

This position is responsible for coordinating referral orders for a continuation of treatment, such as specialty services and diagnostic testing within a multispecialty practice.

This position provides all pertinent clinical information needed for the payor authorization and the facility or specialist prior to the services being rendered.

The position acts as a liaison between the patient and the specialty area by navigating the appointment process, and ensuring that proper authorization(s) are obtained for the appointment, to provide a seamless experience for our patients.

This position is responsible for tracking and managing all referrals with the intention and outcome to close any patient care gaps, along with providing documentation to promote team awareness.

CORE FUNCTIONS

1. Schedules and / or coordinates the scheduling of appointments for incoming referrals to assigned specialty physician services and / or diagnostic testing per provider request and communicates with the patient on a timely basis for all scheduling requirements.

2. Schedules and / or coordinates the scheduling and authorizations for provider pre-planned in office procedures ordered by assigned specialty(ies).

3. Acts as a liaison between patients, providers, departments and staff members for patients’ referral and follow up needs.

Provides prompt and professional service for the patients by assisting in educating patient / family and assisting patients with external resources when needed.

4. Collaborates with providers and departments of assigned specialty(ies) to determine all CPT Codes provider will need authorized before appointment.

5. Provides all pertinent clinical information needed for the payor authorization, the facility or specialist prior to the services being rendered by verifying coverage, obtaining authorization and communicating with receiving facilities for incoming referrals as well as pre-planned in office procedures.

6. Reviews upcoming provider schedules to ensure all appointments have appropriate referral and authorizations required for anticipated visits and procedures.

7. Applies knowledge of medical terminology, ICD-10 and CPT Codes and maintains up to date knowledge of insurance environment.

Utilizes internal and external resources to seek knowledge about regulations regarding various payor sources.

8. Collaborates with outside referral sources and other community resources. Maintains an updated list of community resources and networks with colleagues to develop additional referral sources.

9. This position has frequent communications with patients, physicians, staff, departments and third-party payers. The position must work with and understand the concepts of managed health care and be able to prioritize tasks within established guidelines with minimal supervision.

MINIMUM QUALIFICATIONS

High school diploma / GED or equivalent working knowledge.

Requires knowledge of medical terminology, ICD-10, CPT Codes and a broad understanding of all common insurance and payor types and authorization requirements, normally acquired over a two or more years of work experience in the healthcare field.

Strong knowledge in the use of common office software, word processing, spreadsheet, EMR software are required. Requires the ability to manage multiple tasks simultaneously with minimal supervision and to work independently.

Requires strong interpersonal, oral, and written communication skills to effectively interact with a wide range of audiences.

Knowledge of HIPAA regulations. Strong customer service focus and willingness to problem solve.

PREFERRED QUALIFICATIONS

Additional related education and / or experience preferred.

EOE / Female / Minority / Disability / Veterans

Our organization supports a drug-free work environment.

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Last updated : 2024-05-26