Authorization/Referral Coordinator

Shore Medical Center; Somers Point (NJ); On-site; USD 24,851 - 35,170; Full time

Benefits offered by this job

401(k)

401(k) matching

Life insurance

Paid time off

Referral incentive program

Local community employee discounts

Free Parking

Job summary

A regional healthcare provider based in Somers Point, NJ is in search of an Authorization/Referral Coordinator. This role involves processing referral requests, medication authorizations, and diagnostic imaging pre-certifications. The ideal candidate should have 2-4 years of medical office and medication authorization experience, along with solid knowledge of medical terminology and insurance guidelines. Strong multitasking and decision-making abilities in a fast-paced environment are essential for success in this position.

Qualifications

• 2-4 years of medical office experience required.
• 2-4 years of medication authorization experience is required.
• Ability to work under pressure in a fast-paced environment.

Responsibilities

• Process referral requests and medication authorizations.
• Communicate with payers, providers, and patients effectively.
• Track referrals to meet required timelines.

Skills

Medical terminology knowledge

Insurance guidelines knowledge

Multitasking ability

Decision-making skills

Teamwork promotion

Education

High School diploma or equivalent

Tools

Athena or EMR Experience

Computer Literacy

Job description

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 MedicalOffice Supervisor to ensure implementation and adherence to organizational processes and workflows thatsupports optimal patient care in a multidisciplinary setting.

Responsibilities:

• Reviews, obtains & processes all diagnostic/specialty/miscellaneous referral and authorization requests for boththe 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 systemsandin other systems as required as directed by provider, including appropriately annotating and updating ordersandrequests
• Ensure that specialist reports are received by the primary care provider and are scanned into the electronicmedicalrecord
• 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 precertificationprocesses
• Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow-up isperformed
• Follow medication prior authorization work flow, policies and procedures
• Collaborate with other departments to assist in obtaining medication pre-authorizations in a cross functionalmanner
• Communicates with all involved, payer, provider, and patient as appropriate and as per protocol. Provides astandard 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 andFederal regulations
• Other duties as assigned pertaining to prior authorization, referrals, diagnostic imaging precertifications, and benefit verification/eligibility
• 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 androutines
• Ability to work under pressure, multi-task, make decisions, and work in fast-paced environment
• Promotes and fosters team work

Preferences:

• Athena or EMR Experience
• Computer Literacy – ability to learn and navigate new programs

Salary Range (Based on Experience):

• $18.04 - $25.53

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
• Life insurance
• Paid time off
• 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.