Responsible for timely processing, documenting, scheduling and follow up of referrals and request for treatment authorizations as requested by the primary physician.
Essential Functions of the Job:
- Receives and processes authorizations on timely manner with the at most attention to quality, accuracy and completeness of work. Plans in advance to ensure task are complete and seeks to add value to every work assignment. Schedules requests for referrals and treatment authorizations.
- Demonstrates skills and knowledge to obtain authorizations from various insurance carriers via phone, in writing or electronic media, adjusting effectively to organizational changes maintaining high standards.
- Follows-up on missing documentation to obtain authorization when appropriate; schedules appointment for specialty care, special studies, Durable Medical Equipment (DME) or other ancillary services as requested by the primary care physician.
- Coordinates care within the guidelines of multiple health plans, contracts or insurance types. Uses various modules of the computer system to obtain information, schedule appointments, query information and obtain authorizations.
- Responds to inquiries as to current status of authorization by assessing the request and evaluating the circumstances to provide regular, consistent, timely, and meaningful information to our patients. Demonstrates professionalism verbally and non-verbally, tailors communication styles to the need of the recipient.
- Listens to customers (internal and external) and addresses needs; accountable and responsive to customers concerns. Seeks different points of view and leverages diverse perspectives. Meets established or agreed upon deadlines.
- Arrives on time and prepared for work; uses sound judgment to meet and exceed workplace expectations; assumes responsibility and accountability for decisions, actions, and performance.
- Work on closing the referrals loop; review the referral log weekly to determine which patients have kept their specialty or consultation appointments.
- Update the referral with date and time of the appointment. Document if patient kept their appointment, reach out to Specialist or Facility to request visit notes or results to be faxed to Referrals main fax number within 5 working days of visit.
Additional Duties and Responsibilities:
- Maintains established departmental policies and procedures. Displays and promotes behavior consistent with SYHealth; adheres to standards of ethical conduct and professional compliance.
- Enhances professional growth and development through participation in educational programs, current literature, in-service meetings and workshops; modeling a high performance work ethic and constant self-improvement.
- Attends meetings as required and participates in committees as directed; works cooperatively with others to meet shared objectives. Fosters an environment that encourages group participation and inclusiveness. Takes initiative to improve processes and identify root causes: maintaining a focus on solutions.
- Performs other related duties as assigned or requested by Supervisor or Manager.
Education Required (Minimum level of education): High school diploma or GED equivalent.
Certifications/Licenses Highly Preferred: Current valid California driver’s license, car insurance and or proof of reliable transportation.
Required: A minimum of 1 year experience in healthcare setting to include front with back office or referral authorization knowledge of programs and health plans eligibility and guidelines, coding and data processing or Medical Assistant Certificate.
Preferred: 2 years in healthcare setting
Verbal and Written Skills Required to Perform the Job:
- Bilingual (Spanish/English/ Arabic).
- Good verbal and written communication skills in both languages.
Technical Knowledge and Skills Required to Perform the Job:
- Medical terminology and basic computer.
- Typing of 35 wpm.
- Ability to handle multiple activities simultaneously.
- Be attentive to patient needs and concerns.
- Willing to work with others as a team member.
Equipment Used: Personal computer, Nextgen, FAX.
Working Conditions and Physical Requirements:
- Prolonged sitting position, walking, constant telephone communication.
- May be required to work evenings and/or weekends.