Prior Auth And Referral Coordinator

West Cecil Health Center (WCHC) is seeking a dedicated Prior Authorization and Referral Coordinator to join our team. Under the direction of Practice Manager, the Prior Authorization Coordinator is responsible for coordinating all aspects of the Prior Authorization and Referral processes for office visits, procedures, tests, and pharmaceuticals for patients being seen by the Health Center.

WCHC is a thriving nonprofit, community health organization that provides comprehensive and collaborative patient centered healthcare services. This position is based in Conowingo.

As a Prior Authorization and Referral Coordinator, you will support our amazing care team by:

• Track and monitor referral statuses
• Obtain insurance authorizations from 3rd party payers for referrals to care
• Send referrals and associated documentation to specialist for care coordination
• Coordinate directly with patients to follow-up on that status of their referral
• Obtain copies of consult notes, imaging reports, and lab reports on open referrals
• Attach copies of the consult notes, imaging reports, and lab reports to the referrals
• Document specified quality measures in the patient care record i.e. mammograms and colonoscopies and forward results to the clinical care team
• Communicate any barriers to care to the clinical care coordination team
• Collaborate with the clinical provider to provide alternate pharmaceutical options recommended by insurance carriers for prescription drug coverage
• Adhere to compliance with all regulatory requirements and Health Center policies and procedures including but not limited to HRSA, HIPAA, OSHA, etc...
• Establish and maintain positive and effective relationships with patients, providers, staff, and leadership.
• Ensure a high degree of confidentiality in all transactions
• Document all interactions with patients, providers, payers, and other individuals on behalf of patients clearly, thoroughly, and accurately in the patient's medical record.
• Monitor and respond promptly to inbound calls and/or correspondence and documents related to Prior Authorization of patient care.
• Maintain a working knowledge of Prior Authorization requirements by monitoring all-payer websites/portals and communications.
• Communicate with providers promptly when the insurance company requires a peer-review.
• Other duties as assigned

WHY SHOULD YOU APPLY?

• Growth and Advancement Opportunities
• Company Sponsored Events
• Employee Engagement Committees
• WCHC offers a compressive benefit package including:

1. Medical, Dental, and Vision insurance
2. Health Reimbursement Arrangement
3. Employer paid Life and AD&D and Disability insurance
4. 401K with employer match
5. Generous Paid Time Off and Volunteer time
6. Paid Holidays
7. Education reimbursement

The Prior Authorization and Referral Coordinator job might be for you if you:

• have a high school diploma or equivalent required, AA degree or higher preferred
• have Medical Assistant or Nursing Assistant Certification and/or experience, preferred
• have current CPR certification, recommended
• have Federally Qualified Health Center experience, highly preferred.
• have customer service experience within the health care field.
• have Prior Authorization and Referral experience, preferred
• have experience with coordination of insurance benefits, preferredysical/Environmental
• have normal accessibility and mobility throughout the practices, required
• have the ability to lift and carry items weighing up to 25 pounds unassisted

At WCHC, we embrace diversity and we don’t discriminate against employees or applicants based on gender identity or expression, sexual orientation, race, religion, age, national origin, citizenship, disability, pregnancy status, or veteran status.