[Hiring] Referral & Authorization Coordinator @Wayne Health

Role Description

The Referral and Authorization Coordinator position serves to provide integrated services essential to care delivery and revenue. The R&A coordinator is responsible for:

• Obtaining pre-certifications and pre-authorizations for procedures and specialist referral appointments.
• Scheduling outpatient testing with other providers for Wayne Health.
• Coordinating processes, documenting medical referrals, and prior authorizations for clinic patients.
• Providing excellent customer service when answering incoming calls from patients and the public.
• Scheduling appointments, making follow-up phone calls, addressing complaints, troubleshooting problems, and providing information to patients and the public.
• Demonstrating a commitment to a patient-centric, efficient health care delivery system focused on quality, safety, and operational excellence.

Qualifications

• High School Diploma or equivalent required.
• Minimum 2-3 years insurance, medical prior authorization, billing, or Physician Office experience.

Requirements

• Process referrals and submit medical records to insurance carriers to expedite the prior authorization process.
• Contact insurance carriers to verify patient’s insurance eligibility, benefits, and requirements.
• Schedule appointments for imaging and diagnostic services.
• Request, track, and obtain pre-authorization from insurance carriers within the allotted time for medical services.
• Document and communicate patient correspondence/messages accurately to the appropriate personnel/providers.
• Manage all incoming referral repositories: EHR buckets, provider email, faxes, Auth inbox, Teams message groups.
• Request, follow-up, and secure prior-authorizations prior to services ordered.
• Regularly call insurance companies to follow-up on authorizations.
• Apply detailed knowledge of ICD10 and CPT codes.
• Achieve individual productivity and quality metrics set by management.
• Manage correspondence with insurance companies, physicians, specialists, and patients as needed.
• Review accuracy and completeness of information requested and ensure that all supporting documents are present.
• Prioritize incoming authorizations by level of urgency to the patient.
• Provide excellent customer service, anticipating and responding to needs of others in a courteous and timely manner.
• Maintain excellent interpersonal skills necessary to establish and promote productive working relationships.
• Update patient insurance, email, phone, and all demographics as needed in EHR.
• Monitor insurance changes relative to coverage and authorization requirements.
• Support/perform activities related to appeals of any denied authorization.
• Answer Wayne Health calls.
• Respond to patient/customer inquiries both over the phone and by email.
• Research required information using available resources.
• Respond to and resolve patient complaints.
• Process referral requests.
• Identify and escalate urgent and emergent patient questions.
• Route calls to appropriate resources when unable to resolve the complaint/concern directly.
• Follow up with patients and callers within predefined timeframes set by departments.
• Clearly document all communications and contacts with providers and personnel according to standard operating procedures.
• Exercise sound judgment and decision-making skills.
• Communicate clearly, take initiative, and be flexible.
• Exhibit good interpersonal communication skills.
• Convey a positive and professional image to patients and the public.
• Work well under pressure.
• Contribute to the team effort.

Skills and Abilities Required

• Working knowledge of ICD10 and CPT Codes.
• Able to operate and stay organized when using multiple computer screens and website windows.
• Proficiency in Microsoft Outlook, Teams, Word, and Excel.
• Intermediate medical terminology.
• Basic office skills including typing 35 wpm and accurately entering alphanumeric data.
• Possess excellent verbal, written communication, and problem-solving skills.
• Excellent customer service skills, including independent thinking and sound judgment.
• Attention to detail in documentation and communication.
• Ability to effectively work independently and with a team.
• Manage multiple tasks with shifting priorities.
• Knowledge of medical insurance and medical office billing.
• Proficient in navigating EHR, Nextgen, or Athena system preferred.
• Ability to stand/sit for long periods and lift up to 50 pounds.
• Requires sensitivity to work with seriously ill patients and their families.
• Competency in customer service skills.

Safety Requirements

• Compliance with Department Health and Safety policies and procedures.

Working Conditions/Schedules

• 40-hour work week, hours and days to be determined by the business needs of the department.
• Additional hours may be required.