Authorization/Referral Coordinator

General Summary 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: Reviews, obtains # processes all diagnostic/specialty/miscellaneous referral and authorization requests for both#the provider and facility Search electronic medical records to obtain the required clinical information needed for medical authorization.# Provides all necessary information (medical records, scripts, etc.) to payer Complete all necessary documentation to meet the needs of providers, health plans, and patients Track referrals to assure all required timelines are met or exceeded Update 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 Ensure that specialist reports are received by the primary care provider and are scanned into the electronic#medical#record Reach out to health insurance plans as needed Assures referrals are maintained within appropriate network or payer requirements Process referrals and submit medical records to insurance carriers to expedite medication prior authorization and diagnostic imaging precertification#processes Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is#performed Follow medication prior authorization work flow, policies and procedures Collaborate with other departments to assist in obtaining medication pre-authorizations in a cross functional#manner Communicates with all involved, payer, provider, and patient as appropriate and as per protocol. Provides a#standard of excellence as it relates to customer service and satisfaction for all customers Remains current on referral policies and procedures, and payor guideline requirements Must be able to maintain confidentiality with all aspects of information in accordance with practice, State and#Federal regulations Other duties as assigned pertaining to prior authorization, referrals, diagnostic imaging precertifications, and benefit verification/eligibility Minimum Requirements: HS diploma or equivalent 2-4 years of medical office experience required 2-4 years of medication authorization experience is 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 fast-paced environment Excellent organization skills Promotes and fosters team work Preferences: Athena or EMR Experience Microsoft Office experience Computer Literacy # ability to learn and navigate new programs 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) 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. Nothing contained herein restricts the company#s rights to assign or reassign duties and responsibilities to this job at any time.# 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.

General Summary

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:

• Reviews, obtains & processes all diagnostic/specialty/miscellaneous referral and authorization requests for both the provider and facility

• Search electronic medical records to obtain the required clinical information needed for medical authorization. Provides all necessary information (medical records, scripts, etc.) to payer

• Complete all necessary documentation to meet the needs of providers, health plans, and patients

• Track referrals to assure all required timelines are met or exceeded

• Update 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

• Ensure that specialist reports are received by the primary care provider and are scanned into the electronic medical record

• Reach out to health insurance plans as needed

• Assures referrals are maintained within appropriate network or payer requirements

• Process referrals and submit medical records to insurance carriers to expedite medication prior authorization and diagnostic imaging precertification processes

• Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed

• Follow medication prior authorization work flow, policies and procedures

• Collaborate with other departments to assist in obtaining medication pre-authorizations in a cross functional manner

• Communicates with all involved, payer, provider, and patient as appropriate and as per protocol. Provides a standard of excellence as it relates to customer service and satisfaction for all customers

• Remains current on referral policies and procedures, and payor guideline requirements

• Must be able to maintain confidentiality with all aspects of information in accordance with practice, State and Federal regulations

• Other duties as assigned pertaining to prior authorization, referrals, diagnostic imaging precertifications, and benefit verification/eligibility

Minimum Requirements:

• HS diploma or equivalent

• 2-4 years of medical office experience required

• 2-4 years of medication authorization experience is 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 fast-paced environment

• Excellent organization skills

• Promotes and fosters team work

Preferences:

• Athena or EMR Experience

• Microsoft Office experience

• Computer Literacy - ability to learn and navigate new programs

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)

• 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. Nothing contained herein restricts the company's rights to assign or reassign duties and responsibilities to this job at any time.

• 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.