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Authorization & Referrals Coordinator

2 months ago

Las Vegas, Nevada, United States Cure 4 The Kids Foundation Full time
Job Summary

Cure 4 The Kids Foundation is seeking a highly skilled and detail-oriented Authorization & Referrals Specialist to join our team. As a key member of our clinical operations team, you will be responsible for scheduling appointments, obtaining authorizations for imaging procedures, and managing referrals for various medical services.

Key Responsibilities
  • Authorization and Referral Coordination: Utilize clinical data and knowledge to assist patients in gaining appropriate physician, hospital, radiology, medical group, and community referrals.
  • Referral Processing: Utilize computer software to process referrals and maintain up-to-date referral databases.
  • Authorization Obtaining: Obtain prior authorizations for imaging studies and various procedures ordered by practice providers, utilizing payer authorization tools such as forms, websites, telephone, or fax lines.
  • Patient File Maintenance: Maintain updated patient files with the most current coverage information available.
  • Communication and Coordination: Monitor all incoming communications directed to the department and function as a point of contact for assigned providers to answer and route questions about patient care.
  • Referral and Authorization Management: Process patient referrals and prior authorization requests in accordance with departmental guidelines.
Requirements
  • Education: High school diploma or GED.
  • Experience: Two (2) years of experience in a tertiary patient care setting involving interaction with a variety of medical services, contact with patients and families, and interaction with physicians.
Preferred Qualifications
  • Education: Bachelor's degree in a health-related field.
Skills and Abilities
  • Coordination and Multitasking: Ability to coordinate and oversee the simultaneous execution of multiple tasks efficiently.
  • Coding and Terminology: Strong understanding of CPT, ICD-10 coding, and medical terminology.
  • Insurance and Authorization: Knowledge of managed care and other insurance plan benefits and coverage; including experience with the insurance authorization process.
  • Customer Service: Ability to deliver exceptional customer service against regular background noise and conversations, ensuring clear communication over the telephone both in speaking and listening.