Referral & Authorization Coordinator

This is a fully remote position, open to applicants in Michigan.

📋 Description

• Secure pre-certifications and pre-authorizations for medical procedures and specialist referrals.

• Arrange outpatient testing with various providers associated with Wayne Health.

• Organize, document, and manage medical referrals and prior authorizations requested by clinic providers.

• Respond to incoming calls from patients and the public.

• Schedule appointments for imaging, diagnostic services, as well as new and returning patients.

• Conduct follow-up calls and address any complaints.

• Troubleshoot issues and provide information to patients and the public.

• Process referrals and submit medical records to insurance companies.

• Verify patients' insurance eligibility and benefits.

• Request, monitor, follow up on, and secure authorizations prior to services being rendered.

• Manage referral repositories, including EHR buckets, provider emails, faxes, authorization inbox, and Teams message groups.

• Document and communicate patient correspondence and messages in the EMR.

• Utilize knowledge of ICD10 and CPT codes.

• Meet productivity and quality metrics.

• Review authorization information for accuracy and completeness.

• Prioritize authorizations based on patient urgency.

• Update patient insurance, contact information, and demographics in the EHR.

• Monitor insurance changes that could impact coverage and authorization requirements.

• Assist with appeals for denied authorizations.

• Update patient registration and information.

• Address patient inquiries via phone and email.

• Research information using available resources.

• Resolve and escalate patient complaints and urgent or emergent inquiries.

• Route calls to the appropriate resources.

• Follow up with patients and callers within departmental timelines.

• Document communications in accordance with standard operating procedures.

• Answer calls for Wayne Health and support team operations.

⛳️ Requirements

• High School Diploma or equivalent is required.

• A minimum of 2-3 years of experience in insurance, medical prior authorization, billing, or a Physician Office setting.

• Familiarity with ICD10 and CPT Codes.

• Ability to operate multiple computer screens and website windows while maintaining organization.

• Proficient in Microsoft Outlook, Teams, Word, and Excel.

• Intermediate understanding of medical terminology.

• Basic office skills, including typing at 35 wpm and accurately entering alphanumeric data.

• Excellent verbal and written communication skills, along with strong problem-solving abilities.

• Outstanding interpersonal skills to build and sustain productive relationships with physicians, patients, their families, and others inside and outside the clinical environment.

• Exceptional customer service skills, including the capacity for independent thinking, sound judgment, and creativity when addressing customer issues or concerns.

• Attention to detail in documentation and communication.

• Capability to work effectively both independently and as part of a team.

• Ability to manage multiple tasks with changing priorities.

• Knowledge of medical insurance and medical office billing practices.

• Experience with EHR systems, such as Nextgen or Athena, is preferred.

• Ability to stand or sit for extended periods and lift up to 50 pounds.

• Requires sensitivity when working with seriously ill patients and their families.

• Compliance with Department Health and Safety policies and procedures.

🏝️ Benefits

• Full-time position with a 40-hour work week.

• Additional hours may be required.

• EEO/AA/Veteran/Disability Employer.