What are the responsibilities and job description for the Authorization/Referrals Coordinator - Orthopedics & Sports Medicine - Full Time position at Titus Regional Medical Center?
Job: Authorization/Referrals Coordinator
Classification: Hourly/Non-Exempt
Job Category: 5 Administrative Support Workers
Position Summary
The Authorization/Referrals Coordinator is responsible for obtaining appropriate insurance verification, and all authorization requirements during admission. The Authorization/Referrals Coordinator will also perform authorization activities of inpatient and emergency department patients, denial management and all revenue functions and will need to demonstrate, through actions, a consistent performance standard of excellence to which all work is to conform. The Authorization/Referrals Coordinator facilitates referrals to external specialty offices or services in order to maintain ongoing timely and quality patient care and promotes team awareness and ensure patient safety. The expertise of the Authorization/Referrals Coordinator shall include working knowledge in the area of authorization related activities including pre-authorizations, notifications, edits, denials, etc. The Authorization/Referrals Coordinator shall demonstrate the philosophy and core values of TRMC in the performance of duties.
Essential Functions
- Reviews demographic, billing, and insurance information for accuracy.
- Verifies insurance eligibility and makes necessary corrections.
- Obtains pre-certification and authorization.
- Responds to phone calls and correspondence relating to patient accounts.
- Displays positive and professional communication skills internally and externally.
- Works under pressure and resolves problems.
- Navigates insurance carrier websites.
- Reviews and interprets medical record documentation for patient history, diagnosis, and previous treatment plans to pre-authorize insurance plans determined procedures to avoid financial penalties to patients, providers, and the facility.
- Utilizes payer-specific approved criteria or regulations to determine medical necessity or the clinical appropriateness for inpatient admissions, outpatient facilities, office services, and drugs in terms of type, frequency, extent, site and duration, and considered effective for the patient's illness, injury, or disease.
- Provides referral/pre-notification/authorization services timely to avoid unnecessary delays in treatment and reduce excessive non-clinical administrative time required of providers.
- Submits pertinent demographic and supporting clinical data to payer to request approval for services being rendered.
-Maintains ongoing tracking and appropriate documentation on referrals.
-Ensures complete and accurate demographic and current insurance information during registration.
-Assembles information concerning patient's clinical background and referral needs.
-Provides appropriate clinical information to specialists.
-Contacts review organizations and insurance companies to insure prior approval requirements are met.
-Presents necessary medical history, diagnosis and prognosis information.
-Provides specific medical information to financial services to maximize reimbursement to the hospital and physicians.
-Reviews details and expectations about the referral with patients.
-Assists patients in potential problem solving issues related to the health care system, financial or social barriers
-Acts as system navigator and point of contact to patients and families questions and raising concerns.
-Identifies and utilizes cultural and community resources.
-Establishes and maintains relationships with identified service providers.
-Ensures that referrals are addressed in a timely manner.
-Reminds patients of scheduled appointments via mail or phone.
-Ensures the patient information is up to date on specialist consults, hospitalizations, ER visits and other health related data.
- Performs all other duties as assigned.
- Must maintain composure under stress.
-Follows and adheres to TRMC vaccine policy(s) mandated by the Centers for Medicare & Medicaid Services (CMS).
Work Experience
- One year of previous hospital or medical office experience in billing, pre-certification and authorization preferred.
Education
- Associates degree in related field preferred.
- Completion of a medical terminology course or equivalent preferred.
Physical Demands and Work Environment
Lifting/Carrying Pushing/Pulling
Lbs. % Time Lbs. % Time
1-10 34-66 1-10 34-66
11-20 0-33 11-20 0-33
21-50 0-33 21-50 0-33
51-75 None 51-75 None
76-100 None 76-100 None
Movement % Time
Bend/Stoop/Twist 0-33
Crouch/Squat 0-33
Kneel/Crawl 0-33
Reach above Shoulder 0-33
Reach below Shoulder 0-33
Repetitive Hand 34-66
Grasping 34-66
Squeezing 0-33
Climb Stairs 0-33
Walking Uneven 0-33
Walking Even 34-66
Environment % Time
Indoors 67-100
Outdoors 0-33
Extreme Heat None
Dusty None
Excessive Noise 0-33
Equipment % Time
Motor Vehicles None
Foot Pedals None
Extreme Heat None
Dusty None
Excessive Noise 0-33
Work near % Time
Machinery None
Electricity None
Sharps 0-33
Chemicals 0-33
Fumes 0-33
Heights None
Vision
Depth Perception Required
< 20" Required
Color Not Required
Peripheral Required
Endurance Hours at Once Total in 12HR
Sit 5 10
Stand .5 1
Walk .5 1
Classification: Hourly/Non-Exempt
Job Category: 5 Administrative Support Workers
Position Summary
The Authorization/Referrals Coordinator is responsible for obtaining appropriate insurance verification, and all authorization requirements during admission. The Authorization/Referrals Coordinator will also perform authorization activities of inpatient and emergency department patients, denial management and all revenue functions and will need to demonstrate, through actions, a consistent performance standard of excellence to which all work is to conform. The Authorization/Referrals Coordinator facilitates referrals to external specialty offices or services in order to maintain ongoing timely and quality patient care and promotes team awareness and ensure patient safety. The expertise of the Authorization/Referrals Coordinator shall include working knowledge in the area of authorization related activities including pre-authorizations, notifications, edits, denials, etc. The Authorization/Referrals Coordinator shall demonstrate the philosophy and core values of TRMC in the performance of duties.
Essential Functions
- Reviews demographic, billing, and insurance information for accuracy.
- Verifies insurance eligibility and makes necessary corrections.
- Obtains pre-certification and authorization.
- Responds to phone calls and correspondence relating to patient accounts.
- Displays positive and professional communication skills internally and externally.
- Works under pressure and resolves problems.
- Navigates insurance carrier websites.
- Reviews and interprets medical record documentation for patient history, diagnosis, and previous treatment plans to pre-authorize insurance plans determined procedures to avoid financial penalties to patients, providers, and the facility.
- Utilizes payer-specific approved criteria or regulations to determine medical necessity or the clinical appropriateness for inpatient admissions, outpatient facilities, office services, and drugs in terms of type, frequency, extent, site and duration, and considered effective for the patient's illness, injury, or disease.
- Provides referral/pre-notification/authorization services timely to avoid unnecessary delays in treatment and reduce excessive non-clinical administrative time required of providers.
- Submits pertinent demographic and supporting clinical data to payer to request approval for services being rendered.
-Maintains ongoing tracking and appropriate documentation on referrals.
-Ensures complete and accurate demographic and current insurance information during registration.
-Assembles information concerning patient's clinical background and referral needs.
-Provides appropriate clinical information to specialists.
-Contacts review organizations and insurance companies to insure prior approval requirements are met.
-Presents necessary medical history, diagnosis and prognosis information.
-Provides specific medical information to financial services to maximize reimbursement to the hospital and physicians.
-Reviews details and expectations about the referral with patients.
-Assists patients in potential problem solving issues related to the health care system, financial or social barriers
-Acts as system navigator and point of contact to patients and families questions and raising concerns.
-Identifies and utilizes cultural and community resources.
-Establishes and maintains relationships with identified service providers.
-Ensures that referrals are addressed in a timely manner.
-Reminds patients of scheduled appointments via mail or phone.
-Ensures the patient information is up to date on specialist consults, hospitalizations, ER visits and other health related data.
- Performs all other duties as assigned.
- Must maintain composure under stress.
-Follows and adheres to TRMC vaccine policy(s) mandated by the Centers for Medicare & Medicaid Services (CMS).
Work Experience
- One year of previous hospital or medical office experience in billing, pre-certification and authorization preferred.
Education
- Associates degree in related field preferred.
- Completion of a medical terminology course or equivalent preferred.
Physical Demands and Work Environment
Lifting/Carrying Pushing/Pulling
Lbs. % Time Lbs. % Time
1-10 34-66 1-10 34-66
11-20 0-33 11-20 0-33
21-50 0-33 21-50 0-33
51-75 None 51-75 None
76-100 None 76-100 None
Movement % Time
Bend/Stoop/Twist 0-33
Crouch/Squat 0-33
Kneel/Crawl 0-33
Reach above Shoulder 0-33
Reach below Shoulder 0-33
Repetitive Hand 34-66
Grasping 34-66
Squeezing 0-33
Climb Stairs 0-33
Walking Uneven 0-33
Walking Even 34-66
Environment % Time
Indoors 67-100
Outdoors 0-33
Extreme Heat None
Dusty None
Excessive Noise 0-33
Equipment % Time
Motor Vehicles None
Foot Pedals None
Extreme Heat None
Dusty None
Excessive Noise 0-33
Work near % Time
Machinery None
Electricity None
Sharps 0-33
Chemicals 0-33
Fumes 0-33
Heights None
Vision
Depth Perception Required
< 20" Required
Color Not Required
Peripheral Required
Endurance Hours at Once Total in 12HR
Sit 5 10
Stand .5 1
Walk .5 1
