Care Access Navigator: Referrals & Precertification

Prisma Health; New York (NY); On-site; USD 34,000 - 46,000; Full time

Job summary

Prisma Health invites applications for a referral coordinator to streamline patient entry and ensure accurate authorization for consultations and tests. You will interface with patients, physician offices, and third-party payors to transmit documentation and secure approvals.

The role requires adept knowledge of medical terminology, CPT/diagnosis coding, and HIPAA compliance. You will document all interactions, follow up on referrals, and maintain smooth scheduling across multiple systems.

Qualifications

• Education - High School diploma or equivalent preferred.
• Two (2) years of related work experience in a physician front office preferred.
• Experience with patient registration, electronic scheduling, and authorization/precertification is preferred.

Responsibilities

• Coordinate with outside and internal organizations and insurance companies to obtain prior approvals.
• Record demographic, coverage, and scheduling information in the system.
• Remind patients of appointments via mail, internet, or phone.
• Document referral status and scheduled appointments in the EMR for tracking.
• Act as liaison between provider, patient, and specialist; share necessary clinical information.
• Verify orders and communicate guidelines and location to patients.
• Assist patients with navigating healthcare, financial obligations, or social barriers.
• Respond to scheduling requests and ensure timely, efficient referrals.
• Maintain patient confidentiality per HIPAA and Prisma Health policies.
• Ensure efficient operation of the facility and enhance patient experiences.
• Performs other duties as assigned.

Skills

Customer service

Communication

Interpersonal skills

Health insurance knowledge

Medical terminology

CPT/Diagnosis Coding

Microsoft Office

Education

High School diploma or equivalent

Tools

Microsoft Office

Job description

Prisma Health invites applications for a referral coordinator to streamline patient entry and ensure accurate authorization for consultations and tests. You will interface with patients, physician offices, and third-party payors to transmit documentation and secure approvals.

The role requires adept knowledge of medical terminology, CPT/diagnosis coding, and HIPAA compliance. You will document all interactions, follow up on referrals, and maintain smooth scheduling across multiple systems.