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Job DescriptionJob Description

Referral and Prior Authorization Coordinator - HYBRID

• Full-Time
• Monday - Friday
• Days
• $17.75 - $26.00 (depending on experience, licensing and education)
• Non-Exempt

Hybrid position (Two days in the office, three days from home.)

REQUIRED:  In Office training  6 - 9 mths and perform all essential job functions before moving to a hybrid schedule

Referral and Prior Authorization Coordinator Benefits:

• Annual performance review, performance-based merit increase
• Health, dental and vision benefits available with coverage effective the first of the month following date of hire
• Full complement of voluntary benefits 
• $1,000 annual employer HSA contribution for employees enrolled in CNYFC high deductible health plan
• Free office visits with NP or PA employees who are patients of the practice and enrolled in CNYFC high deductible health plan
• Waiver program for health benefits ($3,000 annually)
• 401K after six months with up to 7% combined employer match and annual discretionary profit-sharing contribution
• Generous paid time-off that increases with years of service
• 8 paid holidays per year
• Closed on major holidays 
• Free onsite parking
• Free lunch daily

CNY Family Care's commitment to excellence sets us apart and guides us as we provide care for our community. The Referral and Authorization Coordinator is responsible for managing and coordinating all patient referrals within a busy primary care office. This coordinator collaborates closely with clinical staff and providers to ensure that information is accurately documented in the medical record, all insurance-required referrals are obtained, and prior authorizations for advanced medical imaging are secured.

Referral and Authorization Coordinator Essential Duties and Responsibilities:

• Responsible for verifying patient insurance benefits, eligibility, and demographic information accurately for corresponding referral.
• Communicate with patients, providers, clinical staff, and insurance companies to ensure timely and accurate processing of referrals.
• Complete the required unique referral form if required by the specialist for referral and/or ensure the required documentation and orders are accurate and complete.
• Ability to read and understand medical terminology and decipher different document types within the Electronic Medical Record (EMR). 
• Ability to work independently and use critical thinking to problem-solve with minimal supervision; identify gaps in documentation and take corrective actions.
• Obtain necessary authorizations and pre-certifications for specialist visits and advanced medical imaging.
• Submit, obtain, and track insurance authorizations.
• Maintain a detailed record of all referral activities and follow-up actions in the Electronic Medical Record 
• Responsible for sending the appropriate medical record documentation to the correct insurance carrier via fax or online authorization website.
• Responsible for sending the appropriate referral documentation to the correct provider using Electronic Medical Record 
• Follow up on referrals by generating reports in Medent to ensure timely follow-up per CNY Family Care policies and procedures.
• Verify appointments and corresponding documentation is attached to close out referrals.  Contact other physician offices to obtain any missing documentation or consult reports needed.  Utilize local RHIO and Community Chart in Medent to obtain documents from other providers and facilities as needed to close open referrals.
• Generate patient correspondence regarding non-compliance with recommended treatment by outside providers/treatment facilities to ensure appropriate follow-through documentation in the patient record.

Referral and Prior Authorization Coordinator Education and Experience:

• High school diploma or general education degree (GED) required; one to two years of college .
• RHIT
• 2 years experience working in a health care setting required. Experience in prior authorizations, insurance verification or medical billing helpful.
• Previous experience using electronic medical record (EMR) system required
• Medent EMR experience candidates highly prioritized
• Must know medical terminology

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