Job Description

Position: Referral and Prior Authorization Coordinator - HYBRID

Full-Time/Part-Time: Full-time

Shift: Days

Schedule: Monday to Friday

Rate of Pay: $17.75 - $26.00 (depending on experience, licensing and education)

Exempt/Non-Exempt: Non-Exempt

Hybrid position (Two days in the office, three days from home.)

In Office training 6 - 9 mths and perform all essential job functions before moving to a hybrid schedule

We offer an incredibly competitive compensation and benefits package to Referral and Prior Authorization Coordinators which includes:

• 17 days of paid time-off in 1st year, increases with years of service
• 7 paid holidays per year, including day after Thanksgiving
• Closed on major holidays
• Year end bonus
• Free on-site parking
• Free lunch daily
• Health, dental, vision, and voluntary benefits to all full time employees
• $3,060 annual payment for waiving health benefits
• Employer contribution to employees enrolled in CNY FC HSA plan
• Free office visits with NP or PA providers for patients of the practice enrolled in CNY FC health plan
• 401K after six months with up to 7% combined employer match and annual discretionary profit sharing contribution
• Educational assistance/Tuition reimbursement is available for career-related education up to $5,250 annually

When you come to work for CNY Family Care you join the best family practice in Onondaga County. Our commitment to service excellence sets us apart. Our Cornerstones: Patient-Centered Medical Home Excellence, Teamwork, Safety, Respect, and Professionalism, guide us as we provide care for our community.

It is especially important to us to create a work environment where people feel welcomed, comfortable, valued, and recognized for their contributions. It goes beyond salary and benefits - we work hard to develop an environment and culture that attracts top-quality talent. That is what sets CNY Family Care apart.

With 28 providers and growing, we are small enough so you are not a number but large enough for you to build your career.

Summary: The Referral and Prior Authorization Coordinator is part of the Referral and Prior Authorization team who is responsible for managing and coordinating all patient referrals within a busy primary care office. This coordinator collaborates closely with clinical staff and providers to ensure that information is accurately documented in the medical record, all insurance-required referrals are obtained, and prior authorizations for advanced medical imaging are secured.

Essential Duties and Responsibilities include the following.

1. Verify patient insurance benefits, eligibility, and demographic information accurately for corresponding referral.
2. Obtain insurance authorization from patient’s insurance company for specialist visits and advanced medical imaging. This may be done by phone, fax, or online depending on insurance company’s process.
3. Track insurance authorizations submitted to insurance company for specialist visits and advanced medical imaging that are pending.
4. Coordinate patient referrals to specialists as requested by providers.
5. Verify all pertinent documentation has been provided for the type of referral requested.
6. Assemble information concerning patient's clinical background and referral needs. Per referral guidelines, provide appropriate clinical information to specialist.
7. Responsible for sending the appropriate medical record documentation to the correct insurance carrier via fax or online authorization website.
8. Responsible for sending the appropriate referral documentation to the correct provider using Electronic Medical Record (EMR).
9. Communicate with patients, providers, clinical staff, and insurance companies to ensure timely and accurate processing of referrals.
10. Compete the required unique referral form if required by the specialist for referral and/or ensure the required documentation and orders are accurate and complete.
11. Ability to read and understand medical terminology and decipher different document types within the Electronic Medical Record (EMR). (Ex: Office note, H&P, Discharge Summary, inpatient consult note, specialty consult note, etc.)
12. Ability to work independently and use critical thinking to problem-solve with minimal supervision; identify gaps in documentation and take corrective actions.
13. Maintain a detailed record of all referral activities and follow-up actions in the Electronic Medical Record (EMR).
14. Follows up on referrals by generating reports in Medent to ensure timely follow-up per CNY Family Care policies and procedures.
15. Verifies appointments and corresponding documentation is attached to close out referrals. Contact other physician offices to obtain any missing documentation or consult reports needed. Utilizes local RHIO to obtain documents from other providers and facilities as needed to close open referrals.
16. Generate patient correspondence regarding non-compliance with recommended treatment by outside providers/treatment facilities to ensure appropriate follow-through documentation in the patient record.
17. Demonstrates professionalism, courtesy and a positive approach to communication, teamwork, and interaction with other team members, clinical staff and patients.
18. Index and route a variety of e-faxed and/or N2N medical documents related to referrals accurately into patient electronic health record in accordance with CNY Family Care’s best practice and established policy and procedures.
19. Perform other duties and responsibilities as required or requested.

Knowledge, Skills, and Other Abilities

• Ability to navigate between multiple systems and multiple computer applications.
• Ability to speak effectively with physicians, providers, and employees of the practice.
• Ability to adapt to change positively in workflow and process.
• Strong verbal and written communication skills.
• Strong organizational skills and attention to detail.
• Strong collaboration and relationship-building skills.
• Ability to prioritize workload, and work under pressure in a fast-paced environment with time constraints.
• Proficient in Microsoft Outlook, Excel, Teams

Required Education, Experience, and Licenses:

• High school diploma or general education degree (GED) required; one to two years of college preferred.
• RHIT preferred
• 2 years experience working in a health care setting required. Experience in prior authorizations, insurance verification or medical billing helpful.
• Previous experience using electronic medical record (EMR) system required
• Medent EMR experience candidates highly prioritized
• Must know medical terminology

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