Authorization/Referral Coordinator

Job Description

location:08244,Somers Point, NJ, United States

Company:Shore Medical Center

Authorization/Referral Coordinator The Authorization/Referral Coordinator is responsible for processing referral requests, medication authorizations, and diagnostic imaging pre-certifications, as access to specialty and ancillary testing services is a key component for the treatment of our patients and the satisfaction of our referring providers. This position works with the Medical Office Manager and Medical Office Supervisor to ensure implementation and adherence to organizational processes and workflows that supports optimal patient care in a multidisciplinary setting. Responsibilities include:

Reviewing, obtaining, and processing all diagnostic/specialty/miscellaneous referral and authorization requests for both the provider and facility. Searching electronic medical records to obtain the required clinical information needed for medical authorization. Providing all necessary information (medical records, scripts, etc.) to payer. Completing all necessary documentation to meet the needs of providers, health plans, and patients. Tracking referrals to assure all required timelines are met or exceeded. Updating the referral, pre-certification, or prior authorization in the electronic medical record and payer systems and in other systems as required as directed by provider, including appropriately annotating and updating orders and requests. Ensuring that specialist reports are received by the primary care provider and are scanned into the electronic medical record. Reaching out to health insurance plans as needed. Assuring referrals are maintained within appropriate network or payer requirements. Processing referrals and submitting medical records to insurance carriers to expedite medication prior authorization and diagnostic imaging precertification processes. Assisting with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed. Following medication prior authorization work flow, policies and procedures. Collaborating with other departments to assist in obtaining medication pre-authorizations in a cross functional manner. Communicating with all involved, payer, provider, and patient as appropriate and as per protocol. Remaining current on referral policies and procedures, and payor guideline requirements. Maintaining confidentiality with all aspects of information in accordance with practice, State and Federal regulations.

Minimum Requirements:

High school diploma or equivalent. 2-4 years of medical office experience required. 2-4 years of medication authorization experience required. Knowledge of medical terminology, insurance guidelines, and medical practice services and routines. Ability to work under pressure, multi-task, make decisions, and work in a fast-paced environment. Excellent organization skills. Promotes and fosters teamwork.

Preferences:

Athena or EMR experience. Microsoft Office experience. Computer literacy and ability to learn and navigate new programs.

Salary Range (Based on Experience): $18.04 – $25.53 Why Join Us? At Shore Physicians Group, we work hard and take pride in accomplishing our mission statement of Treating People Well. We are looking for employees who strive to be the best in their field and enjoy exchanging knowledge in an interactive environment. Shore Physicians Group offers a professional, enjoyable work environment, and generous benefits including:

401(k) matching Medical/Dental/Vision insurance Life insurance Paid time off Tuition reimbursement Certification reimbursement Referral incentive program Local community employee discounts Free parking

Additional Information: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill, and/or ability required. This job description should not be construed as an exhaustive statement of duties, responsibilities or requirements, but a general description of the job. Shore Physicians Group is an Equal Opportunity Employer. All applicants will receive consideration for employment without regard to sex, affectional or sexual orientation, gender, gender identity, orientation or expression; marital status, domestic partnership status, civil union status, pregnancy, race, creed, ancestry, color, ethnicity, national origin, age, disability, religion, genetic information, or veteran status or any other basis prohibited by law.