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Referral Coordinator/Prior Authorization

4 months ago

Mansfield, United States Sturdy Memorial Hospital Full time
Obtains authorization numbers from insurance companies for imaging procedures ordered as required. Completes regular audits and resolves issues. Works with multiple insurance carriers/vendors and keeps current with all changes as they relate to prior authorization. Communicates / interacts with specific divisions in the ASG regarding approved or denied prior authorizations. Communicates with Insurance Verification, the Central Billing Office, and other Departments to resolve prior authorization issues. Manages the daily “Missing Prior Authorization” report received from Insurance Verification. Coordinates process for authorization using defined best practices; specifically, internet applications. Covers the front desk on a rotating basis based on coverage needs. Works on Prior Authorizations as needed and in rotation.

Education/Training

  • High school graduate or equivalent
  • Business School degree preferred.

Licenses/Certification:

  • Certificate in insurance authorization/verification preferred.

Required Qualifications and Skills:

  • Minimum of 2 - 3 years of medical secretarial/administrative support experience
  • 6 -12 months of prior authorization experience  
  • Microsoft Office and internet skills required.
  • Excellent customer service skills
  • Ability to work in a team environment.

Preferred Qualifications and Skills:

  • Command of verbal and written English
  • Must possess excellent people skills and adaptability, creating a favorable department image and associate work environment.
  • Visibly demonstrate commitment to customer relations
  • Continuously invested in continuous Quality Improvement and preventing errors from reaching the patient
  • Engaged in all patient satisfaction initiatives.

Essential Job Functions:

  • Manage Daily patient referrals to specialty departments in a timely manner.
  • Respond to patient messages in a timely manner and within 24 hours.
  • Communicate with patients about their referrals, authorizations, and appointments.
  • Communicate with vendors on updating patient coverages and benefits.
  • Assist patients with problem solving potential issues with coverage, financial and social barriers.
  • Provide medical support services to the providers to ensure a smooth flow of patients through the systems.
  • Work on Prior Authorizations as needed basis.

Age Specific Criteria: Ability to effectively communicate to all age levels served within the scope of the position/assigned areas.

Ability to Meet Job Performance Expectations: Must have the ability to perform the essential functions of the position without posing a direct threat to the health and safety of themselves or other individuals in the workplace, with or without a reasonable accommodation.

Sturdy Memorial Hospital is an equal employment opportunity employer. There is no discrimination because of race, color, creed, age, gender, sexual orientation, national origin, veteran status or disability.