Position Summary
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. Participates in performance improvement and continuous quality improvement (CQI) activities.
Essential Functions and Responsibilities
- Ensures that the PA other department staff are familiar with and apply the required components for PA submission.
- Keeps up to date on ICD-10 & CPT coding revisions as needed for the PA-process.
- Ensures timely submission of PAs once the patient record/PA request is sufficiently completed by the provider to support the process.
- Ensures the necessity of determining the acuity level of the request is upheld, and other staff members are provided with a 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
- 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
Required:
- High School Diploma or GED
Preferred:
- 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
Holly Thompson, Human Resources
hthompson@bluemountainhospital.org | 541-575-3820
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 Care 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/
Apply Now!
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