Prior Authorization Coordinator- Plano, TX Full Time

Concentra Plano , TX 75023

Posted 2 months ago

Overview

From our Dallas corporate headquarters to our clinics and onsite locations, Concentra colleagues remain focused on our driving purpose: Improving the health of America's workforce, one patient at a time. Our commitment is that every patient is treated the Concentra Way: quality clinical care and a positive customer experience from welcoming, respectful and skillful colleagues. We do this by putting all customers first and by displaying:

  • A healing focus
  • A selfless heart
  • A tireless resolve

Position Summary

The Referral Management Coordinator maintains high standards for quality and an exceptional patient experience in accordance with Concentra's policies, procedures and applicable regulations. The Referral Management Coordinator works closely with physicians, employers and payors placing customer services as a top priority to achieve a positive impact on the cost and quality of care rendered to the injured employee.

Responsibilities

The Details

  • First point of escalation for all case related issues requiring guidance

  • Responsible for daily completion of assigned patient referrals, while meeting production requirements

  • Reviews, processes and supports Specialist referral requests by Concentra sites as defined by the market

  • Obtains authorization for Specialist referrals and schedules appointments accordingly

  • Ensures that appropriate networks and Concentra Advanced Specialists are used when applicable

  • Provides all necessary information such as medical records, prescriptions, etc. to payor

  • Communicates with stakeholders, payor, employer, and patient as appropriate

  • Records all appropriate information via OA/CR module of OccuSource per Concentra policy

  • Builds relationships with provider, employer and payor communities

  • Identifies trends or patterns in missed capture and opportunities to gain capture; Communicates these ideas and trends to Lead and Supervisor

  • Handles calls according to the call guidelines of the department

  • Participates in quality assurance processes including but not limited to the audit program, case reviews and training sessions

  • Other duties as assigned

Qualifications

Scope measures

  • Directly responsible for meeting performance requirements and accurate completion of daily assignment

  • Reports to Referrals Supervisor

Education/credentials

  • High School Diploma or equivalent required; Associates degree preferred

  • Proficiency in Microsoft Office (Word, Excel, PowerPoint) and Outlook

  • Proficiency with scheduling / insurance verification software

Job-related experience

  • Minimum of 1 year experience in processing patient referrals in a medical setting

  • Experience with Worker's Compensation preferred

Job-related skills/competencies

  • Excellent written and oral communication skills with ability to communicate effectively with colleagues at all levels of the organization

  • Must display proper business etiquette and be skilled in the arts of diplomacy and tact

  • Excellent time management skills including the ability to multitask and prioritize in a fast paced environment

  • Attention to detail

  • Exemplary decision making and problem solving skills

  • Ability to build and maintain productive business relationships

Working conditions/physical demands

  • Office environment

  • This position requires access to confidential and sensitive information, requiring ongoing discretion and secure information management

Concentra's Data Protection Commitment

  • Concentra is committed to protect patient data and to ensure privacy of personal and medical information.

  • Every Concentra colleague has the responsibility to adhere to data protection principles.

  • If a colleague's role includes handling or processing sensitive data, role-specific policies and requirements apply to ensure the protection of patient information.

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Prior Authorization Coordinator- Plano, TX Full Time

Concentra