Job Title: Referral/Authorization Coordinator
Location: Candidates must live near Hidalgo for occasional in-person meetings
Pay: $19.00 per hour
Work Arrangement: 100% Remote
Experience Required: 1+ Years of Relevant Experience
Our managed care organization is dedicated to improving the healthcare experience for our members. We believe in providing high-quality, accessible care that meets the diverse needs of our communities. As a Referral/Authorization Coordinator, you will play a vital role in ensuring our members receive timely access to the services they require.
The Referral/Authorization Coordinator is responsible for managing the referral and authorization process for our members. This role involves working closely with healthcare providers, members, and internal teams to facilitate the approval of medical services. The Coordinator will ensure that all referrals and authorizations are processed accurately and in compliance with our organization's policies and regulatory requirements.
Referral Management: Receive and process referrals from healthcare providers, reviewing for completeness and accuracy. Verify member eligibility and coverage to determine authorization requirements.
Authorization Processing: Initiate and manage the authorization process, including obtaining necessary documentation and approvals. Communicate with providers to gather additional information when required.
Documentation: Maintain detailed records of all referrals and authorizations in our system. Ensure that documentation is complete, accurate, and up-to-date.
Communication: Collaborate with healthcare providers, members, and internal teams to facilitate the timely approval of medical services. Communicate authorization decisions to the relevant parties.
Compliance: Stay up-to-date with relevant laws, regulations, and policies related to referrals and authorizations. Ensure that all processes adhere to these requirements.
Problem Resolution: Address and resolve any issues or discrepancies related to referrals and authorizations. Escalate complex cases as needed.
Quality Assurance: Conduct regular audits of referral and authorization processes to identify opportunities for improvement. Implement best practices to enhance efficiency and accuracy.
Reporting: Generate reports on referral and authorization metrics, including turnaround times, approval rates, and any outstanding cases.
Training: Assist in training new team members and providers on referral and authorization processes.
Education: High school diploma or equivalent. Some college coursework in healthcare administration or a related field is a plus.
Experience: 1+ years of experience in referral and authorization coordination within a healthcare or managed care setting.
Technical Skills: Proficient in using computer systems and software, including Microsoft Office and relevant healthcare management software.
Communication: Strong verbal and written communication skills. Ability to interact professionally with providers and internal teams.
Organizational Skills: Excellent organizational and time-management skills to manage multiple referrals and authorizations simultaneously.
Detail-Oriented: A keen eye for detail to ensure accuracy in processing referrals and authorizations.
Problem-Solving: Effective problem-solving skills to address issues and discrepancies.
Adaptability: Ability to adapt to changes in policies and procedures.
Team Player: Collaborative and willing to work as part of a team to achieve common goals.
This position is 100% remote, allowing you to work from the comfort of your own home. We offer flexible hours to accommodate your schedule.