Referral Prior Authorization Coordinator
- Expired: June 12, 2022. Applications are no longer accepted.
This position participates with the Health Care Team in delivering quality and customer focused health care to patients in a manner that reflects Coast Community Health Center's mission, vision, and values. The Referral and Prior Authorization Coordinator works closely with providers, staff, specialists, and payors placing customer service as a top priority to achieve a positive impact on the... cost and quality of care rendered to the patient.
CORE JOB RESPONSIBILITIES:Essential Job Duties:Initiates, tracks, and updates status of all referral for patients in a timely manner.Submits prior authorization for diagnostic imaging, prescriptions, and in-house procedures to insurance companies.Communicates with all members of the team, specialists, and insurance companies regarding the referral process to ensure proper coordination of care.Coordinate DME and prescription orders for patients.Understands and possesses knowledge of CPT-ICD-10 codes.Maintains familiarity with pricing and CPT/ICD-10 coding on common referrals and prior authorizations.Demonstrates competent use of EHR systems, including data entry, management of pending referrals, verification, and coordination of services. Possesses the ability and demonstrates working knowledge of insurance referrals.Ensure specialist offices receive necessary documentation to begin patient care.Tracks referral appointments to assure consultation report is received and reviewed by the PCP.Answer phone calls from patients, families, specialist offices, community agencies, insurance companies, and others. SUPPORTING JOB RESPONSIBILITIES:Attends meetings, team huddles, and assigned trainings within an organization.In a timely manner addresses all correspondence, which includes but is not limited to Outlook, EHR encounters, in-office correspondence.Utilizes resources to remain informed of organizational communication (i.e.
Huddle, white board, etc.).Complies with all policies, procedures, guidelines, and workflows.Performs safe work practices to protect the health and safety of employees and patients per OSHA regulation.Protects individually identifiable health information per HIPAA regulation.Ensures the proper and timely documentation in EMR.Completes all required compliance training within the established timeline.Utilizes the incident reporting system as needed.Other duties as assigned. QUALIFICATIONS (SKILLS, KNOWLEDGE & ABILITIES): Work Experience: 3-5 years' work experience in referrals and prior authorization preferredEducation, Training, Certification and Licensure: High school diploma or equivalent required. Skills, Knowledge & Abilities: Medical terminology; Grammar, spelling, and punctuation; Knowledge of EHR system; Proficient with Microsoft Office/Outlook; Attention to detail; HIPAA; CPT/ICD-10 knowledge required.
Demonstrates a proven track record of tenacious problem solving for complex care. EQUAL EMPLOYMENT OPPORTUNITY STATEMENT:Coast Community Health Center provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, marital status, amnesty, or status as a covered veteran in accordance with applicable federal, state and local laws. Coast Community Health Center complies with applicable state and laws governing non-discrimination in employment in every location in which the organization has facilities.
This policy applies to all terms and conditions of employment, including, but not limited to, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training. The undersigned have read this job description and agree that it defines the position as it currently exists and understands that the above is intended to describe the general content of and requirements for this job. It is not to be considered an exhaustive statement of duties, responsibilities, or requirements, and does not limit the as
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