Referral/Authorization Coordinator - FT

Job Summary:

The Referral/Authorization Coordinator is responsible for servicing the needs of patients, providers, and Health Plan representatives by effectively handling referrals from providers to facilitate the clinical review, issue authorizations and coordination of referral services utilizing pre-approved screening criteria in compliance with contracted Client's requirements and adopted clinical guidelines.

Essential Functions:

• Receive referral requests from providers and Health Plan representatives. Assist in processing medical service requests. Completes clerical duties related to the processing of Authorization Requests and Provider Referrals.
• Verify member's eligibility and benefits with subsequent notification to designated staff of eligibility issues.
• Input all requests for services received via fax or phone into the system accurately for electronically generated authorization and tracking.
• Provide service authorizations to providers per UM Departmental Policy and Procedures and specific contracted Client's process in a timely manner.
• Requests for submission of appropriate medical records according to established criteria for requested service(s) in accordance with the corresponding Policy and Procedure.
• Notify required parties within the appropriate timeframe for routine and urgent requests for services.
• Research patient history for duplications and consideration of authorization limits.
• Verify 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 member's demographics.
• Provide effective departmental communication with both internal and external sources.
• Forward authorizations to appropriate department staff in terms of eligibility and other coverage, pricing, and benefit issues.
• Other duties as assigned.

Qualifications

• High school diploma or general education degree (GED); Clinical background, medical coding, or authorization education/training preferred.
• Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring.

Shift: Monday - Friday 8:00am - 4:30pm

****MMH is an equal opportunity employer****