The Referral Coordinator provide support to patients and providers in relationship to seeking prior authorization (PA) for medically necessary services (specialty care, ancillary and diagnostic services, select medications, and DME supplies) ordered by the provider. In addition to general clerical duties of Referral Coordinator, this position assumes LEAD role in training new personnel and communication with providers regarding the processes and data required for prior authorization (PA). Also, Referral Coordinator Lead oversees, produces and reports monthly metrics and status reports for the Prior Authorization/Referral functions to submit to Business Office (billing department requires management reports, trending/process changes to providers). Participates in performance improvement and continuous quality improvement (CQI) activities.
Essential Functions and Responsibilities
- Insures PA other department staff are familiar with and apply required components for PA submission.
- Keeps up to date on ICD-10 & CPT coding revisions as needed for the PA-process.
- Insures timely submission of PAs once the patient record/PA request is sufficiently completed by the provider to support the process.
- Insures the necessity of determining acuity level of the request is upheld and other staff members are provided with definition of acuity levels and understanding.
- Identifies and communicates trending/errors which impede the PA process to providers, management
- and staff members as the process pertains to their work.
- Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications, attending webinars, establishing professional networks, participates in professional organizations.
- Promotes and supports excellent working relationships with the carriers in relationship to the PA process.
- Works with all clinic employees to assist in the understanding of the PA process as needed to promote departmental understanding
- Additional duties as assigned by the Clinic Director and needed to support work flow.
- Ability to communicate clearly to staff, insurance carriers, providers and patients in relationship to the PA process.
- Performs other duties as requested by department supervisor.
Education, Experience & Certification/Licensure
- High School Diploma or GED
- Medical Terminology
- CPT/ICD-10 coding
- 1-2 years of experience related to the position or in a Healthcare / Customer Service setting
For More Information, Contact
Dalaney Tuholski, Human Resources Recruiter
firstname.lastname@example.org | 541-640-6901
Why Blue Mountain Hospital District & Grant County?
The Blue Mountain Hospital District (BMHD) is located in Grant County, Oregon, at the heart of the John Day River, in beautiful, rural, Eastern Oregon. Our District is comprised of a Critical Access Hospital (CAH), Family & Rural Medicine Clinic, Home Health and Hospice, Emergency Medical Services, an Intermediate Care Center and all of the supporting ancillary departments necessary to care for the health and wellness of our community.
Our District spans from John Day to Prairie City, nestled in a valley surrounded by the Blue Mountains. The Strawberry Mountain Range and John Day River Valley offers a variety of outdoor activities, from abundant hiking/mountain biking/horse riding trails, to high and low lakes and ponds. Our area is known to be a “go to” place not just for recreation, but also for big game hunting and fishing!
Join our family-like team and settle into a lifestyle that is hard to beat!
For more information on our area, visit our Grant County Chamber of Commerce and Discover John Day pages at: https://www.gcoregonlive.com/ and https://www.discoverjohnday.com/