Authorization & Referrals Coordinator

Wellstar Health System, Inc.; Augusta (GA); On-site; USD 42,000 - 62,000; Full time

Job summary

Wellstar Health System, Inc. in Augusta, GA is seeking a Referral Specialist to manage the referral process for ambulatory procedures, ensuring authorizations are requested, received, and recorded.

As a primary contact for staff and patients regarding authorizations, insurance plans, and codes, you will coordinate with providers, clinics, and insurers to streamline referrals and maintain accurate records.

Qualifications

• Minimum 2 years clerical experience required or medical office experience preferred.
• Experience with CPT and ICD-9 coding preferred.
• Knowledge of medical terminology and medical ethics.
• Strong time management and communication skills.
• Ability to maintain confidentiality.

Responsibilities

• Coordinates and processes authorizations.
• Acts as liaison between the specialist, primary care physician and insurance carrier to ensure appropriate authorization for specialty procedures.
• Ensures all authorizations include ICD9 / CPT codes with supporting clinical data.
• Expedite authorization process by monitoring the tapestry database.
• Updates tapestry with valid authorization codes, date of service, and insurance contact information.
• Tracks and monitors all clinic authorizations and referrals.
• Documents referrals and conversations regarding authorization requests in the EMR.
• Responds to patient insurance questions/concerns.
• Advocates for and generates appeals and assists with patient needs.
• Maintains utilization data on managed care patients.
• Responds to phone calls from patients, physician offices and insurance plans on referrals.
• Coordinates all aspects of managed care operations.
• Coordinates review of clinic authorizations with Patient Care Manager, Providers and staff as necessary.
• Researches patient eligibility and benefits; communicates with patient accounts and faxes required documentation.
• Contributes to organizational competency and core values; performs other duties as needed.

Skills

CPT & ICD-9 coding

Medical terminology

Time management

Attention to detail

Confidentiality

Education

High School Diploma General

Job description

Wellstar Health System, Inc. in Augusta, GA is seeking a Referral Specialist to manage the referral process for ambulatory procedures, ensuring authorizations are requested, received, and recorded.

As a primary contact for staff and patients regarding authorizations, insurance plans, and codes, you will coordinate with providers, clinics, and insurers to streamline referrals and maintain accurate records.