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Authorization and Referral Nurse
2 months ago
Network Navigation
Position Overview:
ROLE SUMMARY: The Authorization Coordinator plays a vital role within the Network Navigation department, acting as a key resource for both the Authorization Advocates and patients. This position is tasked with addressing more intricate pre-certification, authorization, and referral requirements. The coordinator will engage with healthcare providers, their offices, insurance entities, and Authorization Advocates to resolve patient inquiries and issues. Furthermore, this role will provide support during periods of high demand or when Authorization Advocates face scheduling challenges.
KEY QUALIFICATIONS:
CORE COMPETENCIES:
- Patient-Centric Approach: The Authorization Coordinator must prioritize customer service, maintaining a patient-first mindset.
- Effective Communication: Strong written and verbal communication skills are essential, alongside a solid understanding of medical terminology.
- Organizational Proficiency: This role demands excellent administrative and organizational capabilities to manage responsibilities efficiently.
- Detail-Oriented: The coordinator should possess strong analytical and problem-solving skills, maintaining a keen attention to detail.
- Technical Proficiency: Familiarity with Microsoft Office applications is required; experience with Meditech is a plus.
- Ability to work both independently and collaboratively in a dynamic environment.
- Independently retrieve orders from designated worklists.
- Verify provider orders, authorizations, and locations, ensuring accuracy in all details.
- Access insurance databases to secure prior authorizations and pre-certifications.
- Maintain precise chart documentation as per departmental protocols and insurance regulations.
- Efficiently process referrals and pre-certifications, including gathering necessary medical records and updating patients on their referral status.
- Engage in ongoing communication with specialty offices to confirm patient scheduling.
- Collaborate with fellow specialists and advocates on process enhancement initiatives.
- Accurately document required clinical and non-clinical information in patient charts.
- Serve as a clinical resource for the Authorization Advocates and the broader Network Navigation team.
- Uphold patient confidentiality in accordance with state, federal, and organizational regulations.
- Validate insurance coverage as per established procedures.
- Complete any additional tasks as assigned by management.
Customer Service Competencies:
- Demonstrates a caring and approachable demeanor in all interactions.
- Maintains confidentiality and respects patient privacy.
- Exhibits excellent telephone etiquette and professionalism.
- Provides timely and accurate information to patients, ensuring a positive experience.
CERTIFICATION/LICENSE: RN license is mandatory.
Successful completion of relevant certification courses within the designated timeframe is required.
EDUCATION AND EXPERIENCE: A degree in nursing or a related field is necessary, along with experience in pre-certification and authorization processes being highly preferred.
Proficiency in Microsoft Office and demonstrated ability to manage multiple tasks effectively are essential for success in this role.
Hancock Health is committed to providing equal employment opportunities to all qualified applicants.
