Referral & Authorization Coordinator - Remote

Serving one million patients and their families annually. Advancing medical knowledge, technologies and practices. Developing and educating the next generation of exceptional health care professionals.

With more than 100 locations in hospital-based clinics, outpatient health and specialty care centers, we provide the most advanced medicine and thoughtful, patient-centric care to the greater metro-Detroit community.

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Job Summary:

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, specialist referral appointments; scheduling for outpatient testing with other providers for Wayne Health.

Coordinates processes, documents medical referrals and prior authorizations for a variety of medical services for clinic patients, as requested electronically by clinic providers.

They provide excellent customer service when answering incoming calls from patients and the public, schedule appointments, make follow-up phone calls, address complaints, troubleshoot problems and provide information to patients and public.

The Referral and Authorization Coordinator role demonstrates a commitment to a patient-centric, efficient health care delivery system that focuses on quality, safety and operational excellence.

Principle Duties and Responsibilities:

• Process referrals and submit medical records to insurance carriers to expedited prior authorization process
• Contact insurance carriers to verify patient’s insurance eligibility, benefits and requirments
• Schedule appointments for imaging and diagnostic services
• Schedule appointments for new and returning patients.
• Request, track and obtain pre-authorization from insurance carriers within time alloted for medical and 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 and document all communication in electronic medical record.
• Request, follow-up and secure prior-authorizations prior to services ordered
• Regularly calls insurance companies to follow-up on authorizations
• Applies detail knowledge of ICD
  10 and CPT codes
• Achieve individual productivity and quality metrics set by management
• Manage correspondence with insurance companies, physicians, specialist and patients as needed, including documenting in the EMR.
• Review accuracy and completeness of information requested and ensure that all supporting documents are present
• Prioritize the incoming authorizations by level of urgency to the patient
• Provide excellent customer service, anticipates and respond to needs of others in a courteous timely manner, treat others with care and respect.
• Maintain excellent interpersonal skills necessary to establish and promote productive working relationships with physicians, patients and their families and other individuals both inside and outside the clinical practice area.
• Updates patient insurance, email, phone and all demographics as needed for each patient serviced in EHR.
• Monitor insurance changes relative to coverage, authorization requirments
• Support/perform activities related to appeals of any denied authorization
• Answer Wayne Health calls.
• Schedule appointments for new and returning patients.
• Update patient information and patient registration.
• Responds 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 upscale 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 time frames set by departments.
• Clearly document all communications and contacts with providers and personnel in standarized documentation requirements according to standard operating procedures.
• Exercise sound judgement and decision-making skills.
• Communicate clearly, take initiative and is flexible.
• Exhibit good interpersonal communications skills.
• Convey a positive and professional image to the patients and the public.
• Work well under pressure.
• Contribute to the team effort.

Education, Licensure/Certification, and Training Required for the Job:

• High School Diploma or equivalent required.
• Minimum 2-3 years insurance, medical…