Referral, Authorization & Record Specialist - Shekinah Health and Wellness Center

OVERVIEW: The Referral, Authorization & Record Specialist will assist our medical office with coordinating referral appointments and sending referral forms to our health records department as well as obtaining pre-certifications and pre-authorizations for procedures and medications. Generally, the Referral, Authorization & Record Specialist has many responsibilities, such as tracking and follow up on referral, managing communications for the submitted referrals, to different medical offices, coordinates patient appointments/orders for outpatient testing with other providers, transcribes and triages patient calls to physicians, organizing patient information, ensuring complete and accurate registration, and providing appropriate clinical data to specialists.

The candidate should have at least two years of prior hands-on experience at a growing and fast-paced medical office.

In addition to the professional skills required, the candidate must have excellent attention to detail since they will be responsible for the organization and accuracy of several patient files at the same time. The candidate must be friendly, proactive, a good listener and contributor, patient, graceful and attentive, among other interpersonal attributes.

Referral Duties

• Expediting patient referrals to specialty offices
• Completing referral requests as needed
• Faxing and sending medical records to our various departments for processing
• Communicate with Patients and Partners regarding submitted referral and prior authorization
• Maintain ongoing tracking and appropriate documentation on referrals to promote team awareness and ensure patient safety
• Ensure complete and accurate registration, including patient demographic and current insurance information
• Assemble information concerning patients clinical background and referral needs
• Provide appropriate clinical information to specialist
• Contact review organizations and insurance companies to ensure prior approval requirements are met
• Provide specific medical information to financial services to maximize reimbursement to the hospital and physicians.
• Review details and expectations about the referral with patients

Record Request Duties

• Responding to requests for medical records, also known as release of information (ROI) requests 
• Maintain Records: Maintaining physical medical records and updating electronic health records (EHR) 
• Ensuring Confidentiality: Maintaining the privacy of patients' sensitive information
• Organizing Files: Organizing patient files and maintaining patient statistics 
• Processing Data: Recording and evaluating data, such as patient contact information and medical history
• Complying with regulations: Ensuring medical records are maintained in compliance with legal, ethical, and regulatory requirements
• Data Collection: Collecting patient information, issuing medical files and filing medical records,
• Admission & Discharge: Processing patient admissions and discharge papers.

Prior Authorization Duties

• Request, track and obtain pre-authorization from insurance carriers within time allotted for medical and services.
• Request, follow up and secure prior authorizations prior to services being performed.
• Contact insurance carriers to verify patients insurance eligibility, benefits and requirements.
• Communicates patients financial obligations if applicable.
• Communicate any insurance changes or trends among team.
• Verifies insurance for all scheduled appointments/patients.
• Correctly identifies insurance benefits/co pays and deductibles and documents accurately on verification form.
• Updates demographic information as necessary.
• Makes appointment for specialist / Facilities as needed.
• Informs appropriate staff/patient of authorization/referral requirements.
• Demonstrate and apply knowledge of medical terminology, high proficiency of general medical office procedures including HIPAA regulations.
• Maintains a level of productivity suitable for the organization.
• Clearly document all communications and contacts with providers and personnel in standardized documentation requirements, including proper format.
• Other duties as assigned

REQUIRED QUALIFICATIONS:

• Intermediate computer/software skills: Outlook, Word, Excel, Powerpoint
• Associate degree or equivalent; Bachelors degree is a plus.
• 2-5 years experience in a medical facility
• Accurate data entry and typing skills of 45 WPM+
• Knowledge of medical terminology and insurance
• Relevant training and/or certifications in records, referral and authorization
• Showcase adherence to medical office policies and procedures, including but not limited to standards for safety, attendance, punctuality, and personal appearance.
• Provide 1-3 reference from your most recent medical-relatedposition
• Showcase the ability to work with various Medical Office technology platforms (Dr. Chrono EMR experience is a plus) and Microsoft Office (Outlook & SharePoint experience is a plus).

Essential Professional Skills:

• Excellent verbal and written communication skills
• Excellent organizational and attention to detail skills
• Effective customer relation skills
• Ability to organize and interpret data
• Requires good judgment, tact, diplomacy
• Ability to problem solve
• Able to use a personal computer and related software
• Strong interpersonal skills to complete multiple tasks and prioritize efficiently while shifting priorities as needed to meet day-to-day patient needs
• Strong cognitive and emotional intelligence skills to act calmly and solve problems when faced with challenging patients and medical tasks.
• Ability to thrive in a fast-paced team oriented medical office environment
• Ability to work in a high ethical and honest work culture that listen and guide patients instead of simply respond to their requests
• Ability to maintain a respectful and servant leadership demeanor.  

Physical Requirements:

• Hearing: Adequate to perform job duties in person and over the telephone. Able to use stethoscope and respond to verbal questions.
• Speaking: Must be able to communicate clearly with the patients in person and over the telephone.
• Vision: Visual acuity adequate to perform job duties, including visual examination of patient and reading information from printed sources and computer screens.
• Other: Requires frequent lifting and carrying items weighing up to 30 pounds unassisted including assisting patients when required.

SHWC Employee Retention Benefit Program includes the following:

• Competitive Pay & Wage Increase Planning based on Key Performance Indicators, Role budget and State of Florida Wages Law
• Family oriented & Supportive work Environment (Bring Your Whole Self to Work)
• Professional Development & Career Planning/Coaching
• Flexible day Fridays (Most often)
• Unpaid Time off request flexibility with 2-4 weeks notice (Management approval required)
• Employee Discount Program
• General Healthcare Advice We do not accept our employees as patient. But we will provide general health advice as a goodwill gesture and courtesy, but all employees must work with their own primary care provider to obtain appropriate care.
• Monthly Appreciation Luncheon & Healthy Snacks
• Healthy Drinking Kegan Water
• Play background and uplifting music to motivate our staff and patients
• Open Door Policy. If closed, simply knock. 

The above is intended to describe the general content and requirements for the performance for this position. It is not to be construed as an exhaustive statement of duties, responsibilities, or requirements. I have read the Medical or Nursing Assistant job description and understand the functions and objectives of the position.

SHEKINAH HEALTH & WELLNESS CENTER IS AN EQUAL OPPORTUNITY EMPLOYER