GENERAL ACCOUNTABILITIES

1.Greets all patients, visitors, physicians, and other staff members in a courteous, respectful and professional manner at all time. Responds to all patients with empathy and positive interpersonal skills at all times.

2.Reports for scheduled shift on time and prepared to assume responsibilities.

• Reports to work in proper uniform/attire.
• Leaves for meal break on time and returns on time.
• Varies work schedule to meet the needs of the department.
• Ensures the department manager has approved all scheduled overtime.
• Seek supervisor approval before working beyond scheduled hours that will result in overtime.
• Schedules all time off with supervisor’s approval.
• Strictly adheres to hospital attendance/tardiness policies 100% of the time.
• Performs all duties as assigned.
• Wears I.D. badge in a visible location at all times on hospital property.
• Protects I.D. and access badge and reports any issues or loss immediately to supervisor or to the Human Resource Department.

3.Attends and participates in meetings and is responsible for information communicated at meetings and in email.

• Attends all mandatory in service on a timely basis as scheduled.
• Participates as an active team member at staff meetings.
• Reads communications and acts upon in a positive and informative manner.

4.Identifies own educational needs and maintains appropriate skill level through educational opportunities.

5.Exercise a commitment to practicing behaviors that are in agreement with the spirit of cooperation and reflect the values described in the Code of Mutual Respect and Professionalism.

6.Assists all patients, family members, physicians, visitors, and employees in a professional and courteous manner.

• Extends special attention and sensitivity to all patients, visitors, physicians, and fellow employees.
• Actively promote diversity and inclusion across organization for both patients and coworkers while avoiding any language or actions considered to be discriminatory or derogatory regarding race, creed, color, ethnicity, national origin, religion, sex, sexual orientation, gender expression, age, height, weight, physical or mental ability, veteran status, military obligations, and marital status.
• Assists in maintaining an atmosphere of cooperation and teamwork with other departments and community partners.
• Demonstrates a genuine willingness to prevent or resolve inter-personal conflicts.
• Demonstrates the ability to participate in and/or implement team decisions.
• Adheres to HIPAA and all applicable privacy laws at all times, only sharing information on a “need to know” basis.

7.Follows Infection Control procedures at all times.

• Clinical Personnel: Strictly adheres to standard precautions by adhering to the usage of personal protective equipment when handling blood or body fluids.
• Non-Clinical Personnel: Washes hands and other skin surfaces with soap and water thoroughly and often in an effort to control spreading of germs within the department and facility.
• Adheres to isolation procedures at all times as applicable.

8.Adheres to the following environmental care standards.

• Demonstrates adequate knowledge of safety policies and procedures, the use of MSDS sheets, hazardous material procedures, and safety codes.
• Code Blue, Code Gray, Code Silver, Code Amber, Code Red, Code Orange, Rapid Response Team
• Demonstrates adequate knowledge of security issues, i.e. personal protection, protection of personal and hospital property.

9.Be familiar with and comply with the Mid-Valley Hospital & Clinic Personnel Handbook and Policies.

10.Be familiar with the collective bargaining agreement (Union Contract) of the UFCW 21 and Mid-Valley Hospital.

11.Demonstrates the ability to adapt to varied age-specific patient populations.

• Non-Clinical Personnel: This position has no responsibility for the assessment, treatment, or care of patients. However, the ability to communicate and interact with patients of all ages is required.

Job Summary:  The Authorization/Referral Coordinator works under the delegation of the clinic administrative manager to perform duties as directed and assist servicing the needs of patients, providers, and the Health Plans representatives, by effectively handling referrals from providers to facilitate the clinical review, issue authorizations and coordination of referrals. Is responsible fo verifying insurance information and pre-authorizations for services. Handles complex requests for treatment and authorization requests. 

Education Background and Experience

Minimum Qualifications:

· High school graduate or GED

Required Licensure / Certifications:

· N/A

Required Experience:

· 1-2 years experience.

· Strong customer service skills 

· Insurance Authorizations 

· Basic Computer Skills

Preferred Qualifications:

· Experience with the Cerner   electronic health record system

· Authorization/Referral Coordinator   Experience

· Proficient with understanding of   insurance payors

· Bilingual in English/Spanish

Professional Requirements

· Adheres to dress code, appearance is neat and clean

· Completes annual organization-required and/or job-required educational requirements

· Maintains regulatory requirements

· Wears identification while on duty

· Attends staff meetings and/or reads all meeting minutes

· Reports to work on time and as scheduled, completes work within the designated time

· Maintains employee/patient confidentiality

· Represents the organization in a positive and professional manner

· Participates in the department’s performance improvement activities

· Demonstrates the mission, ethics, and goals of the organization as well as the departmental Scope of Service

· Communication with patients, guests, family, and staff is courteous, respectful, and helpful

· Maintains a clean, safe, and accident-free environment

Authorization/Referral Coordinator Duties

· Receives referral requests from providers and Health Plans representatives. Assist in processing medical services request. Completes clerical duties related to the processing of Authorization Requests and Provider Referrals.

· Easily manages multiple authorization requests at once.

· Verifies member’s eligibility and benefits with subsequent notification to designated staff of eligibility issues.

· Inputs all requests for services received via fax or phone into the system accurately for electronically generated authorization and tracking.

· Properly documents insurance authorization and eligibility information.

· Adheres to processing referrals and authorizations in a timely manner in accordance to MVC referral and authorizations policy.

· Performs re-authorization and eligibility checks in a timely manner.

· Notifies required parties within the appropriate timeframe for routine and urgent requests for services.

· Verifies fax numbers and system updates. Communicates with requesting provider for any identified need to clarify a request for an authorization, such as CPT codes, ICD10, requested timeframes and patients demographics.

· Provides effective departmental communication with both internal and external sources.

· Forwards Authorizations to appropriate department staff or facility in terms of eligibility and other coverage, pricing, and benefit issues.

· Scans, attaches, reviews and effectively works with electronic images as part of the authorization process, including recording the required information from attachments into the authorization fields.

· Collaborates with Managers, Providers and other staff to resolve complex authorization issues.

· Appropriately forwards all referral requests to the next level of clinical review as applicable and after verifying for completeness and appropriateness.

· Coordinates approved outpatient surgical procedures in specialist's office and/or outpatient surgical facilities with health plan's authorization department when applicable.

· Coordinates approved services with Home Health Providers, Plan Discharge Planners and Plan Members as delegated or required by Plan.

· Follows-up on post-claim denials.

• Is a resource      person for PCP to refer to network specialist(s).

· Maintains appropriate logs, records, and reports.

· Documents and communicates areas of concern to supervisor.

Essential Job Functions

1. The authorizations/referral coordinator has frequent contact with the public and often handles sensitive information and will maintain the confidentiality of all patient-hospital or physician-related information.

2. Coordinates patient care along with his/her team leader throughout the shift. 

3. Handles all requests with a positive attitude at the time the request is made. Cooperates with team members in a constructive and supportive manner. Demonstrates ethical conduct and practices in carrying out delegated duties within the scope of practice.

4. Has a strong knowledge base of the scope of practice, and demonstrates the ability to function within the scope of practice.

5. Participates in safety, disaster, and fire protection programs.

6. Follows normal chain of command.

7. Covers for absentee staff as appropriate. 

8. Performs other relevant duties as assigned.