PRIMARY FUNCTION: Obtain authorization from insurance companies to assist patients in the referral process and complete RX-only referrals, ensuring that all necessary documentation is submitted accurately and promptly to facilitate patient access to their specialist appointment.
TYPICAL WORKING CONDITIONS: Work may require sitting for long periods of time, manual dexterity sufficient to operate a keyboard, type at 40 wpm, operate a calculator, telephone, copier, and such other office equipment as necessary. It is necessary to view and type on computer screens for long periods and to work in a high-volume, fast-paced environment. Ability to work remotely is required.
ESSENTIAL FUNCTIONS OF THE JOB: (This list may not include all of the duties that may be assigned.)
Obtain authorizations for all referral requests received as assigned Completes Rx-Only referrals with the necessary documentation including clinical notes, lab results, consult notes and any relevant additionally requested documentation Review and understand documentation required by insurance companies to obtain authorization, including clinical notes, lab results, consult notes Utilize insurance web portals to obtain authorizations as required Accurately documents referral details, including status, authorization dates, authorization number, specialist/facility and other relevant information per policy Effectively communicates updates in referral status with patients, clinicians and office site staff as instructed by the management team Interacts professionally with specialists/facilities and insurance plan representatives Remains current with company, health plan and specialist requirements Prioritizes use of preferred specialist/facility within the EHR Meets productivity standards as determined by management team Ensure productivity is met within the Service Level Agreement standards set by the management team Manage workloads within referrals/notifications/telephone encounters and action bins in EHR to meet established timeframe expectations Works collaboratively with department team members to ensure demand coverage Manages high priority referrals, telephone encounters, actions and requests appropriately Reviews, follows up and updates pending requests daily Communicates and collaborates effectively with Referral Manager, team members and office site staff as needed using the company tools such as Teams and RingCentral without interruption Manages details and documentation with a strong commitment to HIPAA compliance.
Education Requirements: High School diploma or equivalent.
Location: Monterrey, NL, Mexico
Knowledge, Skills & Abilities: Knowledge of medical terminology, grammar, spelling and punctuation to type correspondence. Knowledge of insurance industry. Skills in operating a computer, fax and photocopy machine. Ability to read understand and follow oral and written instruction. Ability to sort and file materials correctly by alphabetic or numeric systems. Ability to speak clearly and concisely. Ability to establish and maintain effective working relationships with patients, employees and the public. Typing ability of 40 w.p.m., word processing and computer experience.
Experience: One year experience in a medical office and/or referral coordinator experience preferred.
The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills, efforts or working conditions associated with the job. It is intended to be an accurate reflection of the general nature of level of the job.