Job Description

Essential Duties and Responsibilities (Including, but not limited to):
1. Coordinates all incoming and outgoing referrals ordered/received by the providers in the clinic within
two (2) business days of the order being submitted.
2. Ensures orders are completed in the electronic health record and linked to the referral requested.
3. Validates continuity of care and network integrity based on service line availability for quality patient care.
4. Sends all required and appropriate documentation to the referral provider for services requested and
ensures patient records are updated appropriately.
5. Schedules and notifies patient of referral appointment, provides appointment information (date, time,
directions, etc.), and contact information of the referral provider.
6. Provides and/or obtains required authorization for services as needed and works with patient
insurance to validate coverage of services; continuously follows up with the insurance company until
there is resolution of the prior authorization request — an approval, redirection, or denial. All activity
including pre-cert number is recorded in the “Authorization Workflow” within Athena and/or practice
management system.
7. Coordinates with appropriate staff or obtains information relative to the patients out of pocket
expense, including co-insurance and deductibles; also works with patients to establish a plan to pay in
advance of scheduling procedures or follow up care as ordered in accordance with established policies
and procedures. All activity is documented in Athena and/or the practice management system.
8. Ensures patient has the information necessary to make critical care decisions and may provide
information to patient caretakers in accordance with HIPAA.
9. Demonstrates excellent communication and problem-solving skills when assisting with questions or
resolving problems with patients, patient families, and other clinic staff.
10. Maintains confidentiality with patient’s financial, personal, and medical information according to
HIPAA guidelines.
11. Follows proper chain of command and reports issues, problems, opportunities, and important
information to Revenue Cycle Supervisor, Manager, Director and/or Clinic Supervisor, Manger,
Director.
12. Responsible for all other duties as assigned by clinic leadership.

Application Instructions

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