Remote Referral Coordinator - Pre-Authorization

Intermountain Health; Boston (MA); Remote; USD 27,000 - 39,000; Full time

Benefits offered by this job

Benefits eligible

Job summary

Intermountain Health Lutheran Hospital is offering a fully remote Referral Representative role focusing on processing insurance pre-authorizations for primary and specialty visits and tests. You will gather information from patients, providers, and insurers, acting as the patient advocate and ensuring accurate documentation in EMR systems.

The position supports coordination between clinical staff, health plans, and patients, with responsibilities including cost estimates, pre-registration, and

Qualifications

• Have a level of computer literacy that ensures accuracy and timeliness.
• Demonstrated ability to work well with coworkers and patients.
• Ability to collaborate with multiple teams.
• Skill to write clearly and professionally.
• Be thorough, precise and detail oriented.
• Knowledgeable in navigating Microsoft systems (Word, Outlook, Excel, OneNote).

Responsibilities

• Administrative departmental support, including processing into and through electronic medical records internal, external, and outbound referrals while assembling, researching, and triaging information about patient demographics, insurance, and medical needs.
• Maintains ongoing tracking and appropriate detailed documentation of referrals to promote team awareness and ensure patient safety.
• Follows regulatory requirements as defined by provider or specialty department to route inbound referral appropriately. Including appropriate documentation, imaging, or any other requirements while maintaining Intermountain standards for adding and scanning required information into electronic medical records.
• Liaison between patient, clinic, and insurance carrier to set details related to upcoming visit with Intermountain providers or scheduled procedures prior authorization requirements. Coordinates provider peer to peer interactions as it pertains to obtaining insurance approvals. Generates cost estimates for services as it relates to office visits and in-office testing; directs patients to financial counseling resources when appropriate.
• Contacts insurance company representatives or their contracted review organizations to ensure prior approval requirements are met. Presents necessary medical information such as history, diagnosis, and prognosis. Assumes the advocate role on the patient’s behalf with the insurance carrier to ensure approval of necessary services for the patient in a timely fashion.
• Multiple partnerships with Patient Service Representatives and Clinical Staff for effective pre-registration and pre-visit preparation as needed. Also collaborates with Payer Relations to provide the required documentation relating to any denial or appeal information needed. All other duties as needed.
• Utilization of different insurance platforms and medical records systems according to department protocols to include accurate data entry and retrieval of information for reporting purposes.
• Meets performance standards, volume metrics while aligning with mission, vision, and values.

Skills

Detail-Oriented

Medical Terminology

Customer Service

Medical Records Management

Critical Thinking

Researching

Communication

Documenting

Tools

EPIC

Microsoft Word

Microsoft Outlook

Microsoft Excel

Microsoft OneNote

Job description

Intermountain Health Lutheran Hospital is offering a fully remote Referral Representative role focusing on processing insurance pre-authorizations for primary and specialty visits and tests. You will gather information from patients, providers, and insurers, acting as the patient advocate and ensuring accurate documentation in EMR systems.

The position supports coordination between clinical staff, health plans, and patients, with responsibilities including cost estimates, pre-registration, and