Care Access Navigator: Referrals & Authorizations

CommonSpirit Health; Federal Way (WA); On-site; USD 52,000 - 72,000; Full time

Job summary

Virginia Mason Franciscan Health is seeking a Referral Specialist to orchestrate patient access by managing referrals and authorizations with precision.

You will proactively obtain clearances for specialty visits, coordinate appointments and ancillary services, educate patients on insurance benefits and costs, and maintain accurate records to ensure seamless care delivery for our patients in the Puget Sound region.

Qualifications

• Successful completion of an accredited medical terminology course(s) or equivalent on the job training.
• One year of progressively responsible work experience that would demonstrate attainment of the requisite job knowledge/abilities.

Responsibilities

• Manage Referrals and Authorizations: Process referral orders and pre-authorizations, verify insurance eligibility, and secure approvals for diagnostic testing, procedures, specialty care, therapy, and surgeries before services are provided.
• Coordinate Patient Appointments and Care Services: Schedule and coordinate clinic visits, referrals, ancillary services, and related care activities while ensuring all required documentation and authorizations are in place.
• Provide Insurance, Billing, and Financial Guidance: Educate patients on insurance benefits, referral requirements, billing processes, cost estimates, and financial policies; elevate complex financial inquiries as appropriate.
• Maintain Accurate Patient Records and Documentation: Update electronic medical records, document patient interactions, scan and file records, track referral status, and ensure all information is complete and accurate.
• Communicate and Follow Up with Patients and Care Teams: Serve as a liaison among patients, providers, referring clinics, and insurers; notify stakeholders of referral decisions, additional requirements, appointment changes, and missed visits.
• Support Patient Education and Referral-Related Resources: Provide pre-visit instructions, educational materials, registration requirements, and coordinate referral-related equipment or resources, including follow-up on equipment returns when applicable.

Skills

Attention to detail

Organizational skills

Clear communication

Customer service

Education

Medical Terminology Certification

Job description

Virginia Mason Franciscan Health is seeking a Referral Specialist to orchestrate patient access by managing referrals and authorizations with precision.

You will proactively obtain clearances for specialty visits, coordinate appointments and ancillary services, educate patients on insurance benefits and costs, and maintain accurate records to ensure seamless care delivery for our patients in the Puget Sound region.