ABOUT AUSTIN REGIONAL CLINIC:
Austin Regional Clinic has been voted a top Central Texas employer by our employees for over 10 years! We are one of central Texas’ largest professional medical groups with 25+ locations and we are continuing to grow. We offer the following benefits to eligible team members: Medical, Dental, Vision, Flexible Spending Accounts, PTO, 401(k), EAP, Life Insurance, Long Term Disability, Tuition Reimbursement, Child Care Assistance, Health & Fitness, Sick Child Care Assistance, Development and more. For additional information visit https://www.austinregionalclinic.com/careers/
PURPOSE
Under supervision of the Centralized Authorizations and Referrals Supervisor, is responsible for obtaining authorizations and coordinating the care of patients that are referred to a specialist. Acts as a resource for patients and staff with authorization and/or referral related questions/problems requiring resolution. Carries out all duties while maintaining compliance, confidentiality, and promoting the mission and philosophy of the organization.
ESSENTIAL FUNCTIONS
- Assists with responsibilities and duties of the Referral Coordinator I role as directed by department leadership.
- Maintains current knowledge of insurance authorization and/or referral requirements.
- Obtains authorizations from insurance carriers in a timely and efficient manner as defined in the department guidelines.
- Acts as a resource for patients and staff with authorization and/or referral related questions/problems requiring resolution.
- Communicates authorization and/or referral information to patients and specialist offices in a timely and efficient manner.
- Serves as a liaison between Primary Care and Specialty offices.
- Reviews chart to determine appropriate clinicals to send to insurance as requested.
- Can create, modify and sign referral orders within protocols.
- Responsible for coordinating medical record information for transmission to specialist’s office.
- Ensures authorization and/or referral information is properly documented in Epic as outlined in the department guidelines.
- If aware, informs physician of patient compliance with referral plan.
- Informs physicians and management of any issues causing a delay in authorization process.
- Communicates changes and important information to patients and leadership.
- Works efficiently with all departments to promote teamwork within the organization.
- Adheres to all company policies, including but not limited to, OSHA, HIPAA, compliance and Code of Conduct.
- Regular and dependable attendance.
- Follows the core competencies set forth by the Company, which are available for review on CMSweb.
- Works holiday shift(s) as required by Company policy.
OTHER DUTIES AND RESPONSIBILITIES
- Assists with training team members as needed.
- Involvement in organizational development through meeting attendance and committee involvement.
- Responsibilities occasionally may require an adjusted work schedule, overtime, and evening/weekend hours in order to meet deadlines.
- Performs other duties as assigned.
QUALIFICATIONS
Education and Experience
Required: High school diploma or equivalent. Six (6) months or more experience working in the office of a healthcare related facility.
Preferred: Previous experience in insurance authorizations strongly preferred. Previous experience in a high-volume customer service environment and/or experience with contact center phone system a plus.
AND
Knowledge, Skills and Abilities
- Strong knowledge in business office functions and ability to serve as a resource to staff.
- Knowledge of medical insurance and authorization requirements.
- Knowledge of medical terminology.
- Strong knowledge of procedural and diagnostic coding.
- Strong communication and interpersonal skills.
- Skill with operating PC and using the following software applications: MS Outlook, Word, Excel, and Microsoft Office OneNote.
- Excellent computer and keyboarding skills, including familiarity with Windows.
- Excellent verbal and written communication skills.
- Ability to provide excellent customer service.
- Ability to analyze problems, make decisions, and manage conflict.
- Ability to engage others, listen and adapt response to meet others’ needs.
- Ability to align own actions with those of other team members committed to common goals.
- Ability to manage competing priorities.
- Ability to perform job duties in a professional manner at all times.
- Ability to understand, recall, and communicate, factual information.
- Ability to understand, recall, and apply oral and/or written instructions or other information.
- Ability to organize thoughts and ideas into understandable terminology.
- Ability to apply common sense in performing job.
Work Schedule: Monday- Friday, 8am-5pm. Work from home opportunity once orientation complete.