Referral Authorization Jobs (NOW HIRING)

MAUI MEDICAL GROUP, INC.                                                 POSITION DESCRIPTION

Position Title

Department

REFERRAL COORDINATOR

PATIENT SERVICES

INSTRUCTIONS:

In Section A briefly describe the overall purpose of this position.  Describe the position so that someone who does not know the position will understand it.  In Section B describe the specific tasks or duties.  The percentage of time spent performing the major job responsibilities is used for job evaluation purposes only.  In Section C list the minimum qualifications, type of equipment used (including the frequency), characteristics, environmental factors relating to this position.

SECTION A: OVERALL PURPOSE OF THE POSITION

The Referral Coordinator is our lead staff member responsible for receiving referral authorization requests from providers’ offices and obtaining from insurance companies the required authorizations and precertification based on current insurance guidelines.  Coordinates and ensures information between the providers’ offices and insurance companies are accurate.  Tracks referrals for timely completion.

SECTION B: MAJOR JOB RESPONSIBILITIES

*

PERCENTAGE

1. Receives and coordinates referral authorization requests from providers’ offices.  Verifies accuracy and completeness of referral request.  Submits referrals, as required based on current insurance guidelines, to insurance companies for authorizations and precertification.  Tracks and follows up with referral requests for timely completion. Records and forwards approved or denied requests to providers’ office.  Works collaboratively with MMG leadership to direct referrals to preferred provider when deemed appropriate.

*

50

1. Supervise Referral Clerk(s).

15

1. Reviews and implements insurance guidelines.  Educates as needed.

*

15

1. Records, analyzes and reports statistical data for referral tracking system.

5

1. Corresponds with or contacts all parties involved to include outside physicians, insurance companies and nursing personnel to complete the referral/authorization.

5

1. All other miscellaneous responsibilities and duties as assigned.

5

1. Demonstrates quality work, completes assignments on a timely basis, and makes decisions within limits of authority.   Takes initiative in problem solving, maintains confidentiality of patient and company information, and interacts with patients, co-workers, and management in a courteous and respectful manner.  Adheres to all company policies and procedures.

2.5

1. Maintains attendance standards consistent with company policy.

2.5

TOTAL:

           100%

Enter an asterisk (*) in this column to indicate Major Job Responsibilities that are essential functions.

SECTION C: OTHER INFORMATION

Responsible To:

Business Office Manager

Supervises:

None

Minimum Qualifications:

Education/Experience -

High school diploma or equivalent and (2) years of medical experience in healthcare insurance administration.

Skills/Knowledge -

Possess working knowledge of medical and/or healthcare insurance terminology.  Manages multiple tasks at the same time and works overtime as the need arises.  Demonstrates computer literacy (i.e. EMR, referral tracking system, Excel, Microsoft word, etc.).

Shows the ability to supervise department staff members.

Desired/Preferred Qualifications:

Demonstrates effective written and verbal communication skills.

Equipment Use:

Personal computer, fax, telephone, copier, scanner

Characteristics:

Willingly participates as a team member.  Possesses effective organizational skills and maintains a “can-do” attitude.  Recognizes the confidential nature of work and understands and follows HIPPA rules.

Environmental Factors:

Requires walking (15%) and prolonged periods of sitting (85%).  Lifts up to 25 lbs.  Requires manual dexterity sufficient to operate a keyboard and other office equipment.  Vision must be correctable to 20/20 and hearing must be in the normal range for telephone contacts.

Hourly Rate:

Starting @ 19.01; based on experience