Referrals & Authorization Care Coordinator

Community Health Systems; Enterprise (AL); On-site; USD 42,000 - 56,000; Full time

Job summary

Community Health Systems is seeking a Care Coordination Specialist to assist in coordinating patient referrals and authorizations for services within physician practices and clinics. You will collaborate with providers and staff to ensure orders are submitted and documentation is sent to referral providers, and you will notify patients of appointment times and locations.

The role emphasizes attention to detail, independence, and professional communication with patients and families, with daily

Qualifications

• Associate Degree In medical related field preferred or
• Technical School In medical related field preferred
• 0-1 years One (1) year of experience in a medical or health-related field of work required and
• 0-1 years One (1) year of experience in a medical or health-related field of work specializing in referrals/authorizations preferred

Responsibilities

• Coordinates all incoming and outgoing referrals ordered/received by the providers in the clinic within two (2) business days of the order being submitted.
• Ensures orders are completed in the electronic health record and linked to the referral requested.
• Validates continuity of care and network integrity based on service line availability for quality patient care.
• Sends all required and appropriate documentation to the referral provider for services requested and ensures patient records are updated appropriately.
• Schedules and notifies patient of referral appointment, provides appointment information (date, time, directions, etc.), and contact information of the referral provider.
• Provides and/or obtains required authorization for services as needed and works with patient insurance to validate coverage of services; continuously follows up with the insurance company until there is resolution of the prior authorization request — an approval, redirection, or denial. All activity including pre-cert number is recorded in the “Authorization Workflow” within Athena and/or practice management system.
• Coordinates with appropriate staff or obtains information relative to the patients out of pocket expense, including co-insurance and deductibles; also works with patient to establish a plan to pay in advance of scheduling procedures or follow up care as ordered in accordance with established policies and procedures. All activity is documented in Athena and/or the practice management system.
• Ensures patient has the information necessary to make critical care decisions and may provide information to patient caretakers in accordance with HIPAA.
• Demonstrates excellent communication and problem-solving skills when assisting with questions or resolving problems with patients, patient families, and other clinic staff.
• Maintains confidentiality with patient’s financial, personal, and medical information according to HIPAA guidelines.
• Follows proper chain of command and reports issues, problems, opportunities, and important information to Revenue Cycle Supervisor, Manager, Director and/or Clinic Supervisor, Manager, Director.
• Performs other duties as assigned.
• Maintains regular and reliable attendance.
• Complies with all policies and standards.

Job description

Community Health Systems is seeking a Care Coordination Specialist to assist in coordinating patient referrals and authorizations for services within physician practices and clinics. You will collaborate with providers and staff to ensure orders are submitted and documentation is sent to referral providers, and you will notify patients of appointment times and locations.

The role emphasizes attention to detail, independence, and professional communication with patients and families, with daily