Job Description

Summary:
This primary function of this position shall be to coordinate the timely completion, monitoring, and submittal of all incoming and outgoing third party payer referrals for primary care departments. The position will work closely with providers, insurers, and patients in obtaining, resolving, documenting, and communicating referral preauthorizations for specialist services and/or diagnostic testing procedures. The position will be a primary liaison with third party/managed care insurers to stay informed of the latest changes and developments with preauthorization referral procedures. Inclusive within this responsibility and equally important will be the maintenance of the incoming and outgoing referral databases on the Electronic Health Record Systems. Responsibilities:
(40%)* Works with the providers, office staff & outside sources to complete third party referral authorization forms accurately and timely, transmitting some via mail, fax, telephone, or electronically on a frequent basis. Completes prior authorizations for testing and procedures, such as magnetic resonance imaging (MRI) and computerized axial tomography (CT) scans.


(40%)* Enters and tracks incoming and outgoing referrals using Electronic Health Record systems; compiles monthly statistical reports on referral utilization for management reporting purposes on an occasional basis.


(20%)* Coordinates investigation into and responds to disputed or incomplete referral requests on a weekly basis including authorizations and follow up on specialty appointments.


OTHER DUTIES AND RESPONSIBILITIES:
Ability to handle multiple tasks and stressful situations.


Must be able to communicate verbally in person, on the phone and in writing. Frequently position requires regular public contact, decision-making and exposure to stress.


MyMichigan Health is a technology driven organization and employees need to demonstrate competency in Microsoft\xc2\xae Windows. An employee may be required to participate in further learning opportunities offered by MyMichigan Health. Required Education:
Education: HIGH SCHOOL

Equivalent Experience: Associate degree is preferred.
Education Specialization: GENSTUDY
Essential: true

Certifications and Licensures:
N/A Other Information:
EXPERIENCE, TRAINING AND SKILLS:
Two to four years medical office experience.


Excellent interpersonal/customer relations skills and be able to work independently required .


Advanced medical terminology, knowledge of obtaining prior authorizations, ICD-9/ICD10, CPT coding experience within physician practice and knowledge of third payer rules, and medical record charting/documentation experience required. Clinical experience preferred.


PHYSICAL/MENTAL REQUIREMENTS AND TYPICAL WORKING CONDITIONS: Exposure to stressful situations, including those involving public contact, as well as, trauma, grief and death.
Able to wear personal protective equipment that includes latex materials or appropriate substitute if required for your position.
Is able to move freely about facility with or without an assisted device and must be able to perform the functions of the job as outlined in the job description.
Overall vision and hearing is necessary with or without assisted device(s).
Frequently required to sit/stand/walk for long periods of time. May require frequent postural changes such as stooping, kneeling or crouching.
Some exposure to blood borne pathogens and other potentially infectious material. Must follow MyMichigan Health bloodborne pathogen and TB testing as required.
Ability to handle multiple tasks, get along with others, work independently, regular and predictable attendance and ability to stay awake.
Overall dexterity is required including handling, reaching, grasping, fingering and feeling. May require repetition of these movements on a regular to frequent basis.
Physical Demand Level: Sedentary. Must be able to occasionally (0-33% of the workday) lift or carry 0-10 lbs.


Established written and verbal communication skills, good organization and prioritization skills.


Must be a proficient computer user; experienced in Windows, Word Processing, and medical practice software and possess Medic Computer knowledge. Experience in database application and skills preferred.