General Information
| Job Description | MED OFC SVC CRD 3 | Working Title | Authorization Coordinator - Women's Health |
|---|---|---|---|
| Job Code | 009214 | Grade | |
| Department Name | Clinical Affairs - D02007 | Department Head | Krystal Rivas |
| Supervisor | Fernando Reyes | Effective Date | 07/23/2023 |
Position(s) Directly Supervised
| Job Code | Title | FTE |
|---|
Department Custom Scope
| This position will provide a broad array of services for out patient clinics and serve as the subject matter expert responsible for coordinating the delivery of healthcare services to patients by securing all incoming and outgoing patient authorizations and referrals for healthcare services. For incoming patients to UCR Health - reviews referral, obtains information, prepares a file for the physician review for a determination on whether the patient can be seen in the clinic. For current patients, works with other healthcare entities to ensure proper documentation is obtained and sent to the other entity to facilitate the patient to be seen by other specialists, providers, hospitals, etc. At times, may work in the front office reception or call center to facilitate clinic and patient operations. This position may be assigned to work remotely and at various UCR Health clinic locations. This position may be required to work different shifts, including evenings, weekends, and holidays. |
Education & Experience Requirements
Education Requirements
Experience Requirements
| Experience | Requirement |
|---|---|
| A minimum of three (3) years of experience working in a medical environment office role with demonstrated experience of the referral, authorization, and/or patient flow process. | Required |
| Knowledge of healthcare insurance systems, which may include Medi-Cal, MediCare, HMO, PPO, fee for service, county funded coverage, and workers' compensation, sufficient to properly obtain and track authorizations, make patient appointments, make referrals for consultations, diagnostic and ancillary services, coordinate hospital services, complete and submit billing documentation, and explain provisions and requirements to patients. | Required |
| Previous electronic medical records (EMR) experience. | Preferred |
| Prior experience working in a UC Health or combined healthcare/academic setting. | Preferred |
| A minimum of one (1) year of experience working in a women's health setting completing work related to patient eligibility, referrals, and authorizations. | Preferred |
License Requirements
Certification Requirements
| Certification | Requirement |
|---|
Educational Condition Requirements
| Condition | Requirement |
|---|
Key Responsibilities
| Description | % Time |
|---|---|
| Authorization Coordinator: Request authorizations from the payer via their designated process, which may include phone, fax, and/or web portals for office visits, procedures and medications, scheduling appointments within and outside of UCR Health. Verify eligibility and insurance benefits for requested procedures and medications, confirming and obtaining appropriate authorization for office visits and procedures, informing patients of their financial responsibility before their appointment, scheduling procedures, and sending out confirmation letters with appropriate preparation instructions. Discharge patients after medical visits, arrange for follow-up appointments, process referrals for Medi-Cal, Medicare, Managed Care, County, private insurers, and self-pay. Task patient referrals at time of patient discharge via the electronic medical record (EMR) system. Request authorization/referral authorizations from insurance plans including Medi-Cal Manage Care. Adhering to the established criteria and timeframes for processing urgent authorization or referral requests. Schedule follow-up appointments using the electronic medical record system. Assist patients with obtaining new and refill prescriptions and over the counter medications. Serves as an initial point of contact | 45 |
| Referrals: Coordinate referrals from physicians and health care facilities for patients; provide a significant level of patient education related to facilitating the administrative tasks for their illness and planned treatment; and provide a high level of analytical services over the telephone. These services include, but are not limited to: patient to physician communication, physician-to-physician communication, serve as a resource and contact for information and services, referral source to UCR Health and utilization of our EMR system to communicate patient care and schedule & register a variety of appointments effectively and efficiently. Obtain patients labs and other tests results as needed for referral process. Request authorization/referral authorizations from insurance plans including Medi-Cal Manage Care. | 30 |
| Patient Visit Type Coding/Billing Review patient records and complete data collection forms using ICD9/ICD10 and CPT codes. Consult with providers and conduct patient phone follow-ups. Reviews and maintains patient accounts, secures financial arrangements on self-pay balances prior to and during patient appointments, verifies and pre-registers patients. Responds to patient inquiries concerning their bill and account balances to resolve internal accounting and billing errors working closely with UCR Health and responds to patient with disposition on concern. Maintains patient accounts by obtaining, recording, and updating personal, financial, and compliance information into the Electronic Medical Record (EMR). | 10 |
| Responsible for the coordination of new patient requests coming in via the UCR Health website and reviewing with the designated physician. Contact the patient using the information from patient inquiry/web form, collect demographics to pre-register the patient, check eligibility, review or secure referral and if approved proceed with scheduling patient visit. | 10 |
| Special Projects / Travel May participate in projects to enhance the clinic operations, patient experience, or compliance with regulatory agencies. Provide administrative support to medical providers and medical staff. May be required to travel to other UCR Health clinic locations and UC Riverside campus offices. | 5 |
Knowledge, Skills & Abilities
| Knowledge/Skill/Ability | Requirement |
|---|---|
| Must demonstrate customer service skills appropriate to the job. Ability to recognize and handle customer complaints. Ability to accurately handle a high volume of work in a fast paced environment with compassion, patience and positive attitude. | Required |
| Must possess the ability to multi-task between identifying areas for improving patient relations, ensuring that quality standards are met while providing extensive personalized customer service, and executing patient and operational activities. | Required |
| Excellent customer service and strong interpersonal skills. | Required |
| Knowledge of pertinent laws, regulations, and guidelines governing medical records, confidentiality, privacy and provisions to others, including HIPAA. | Required |
| Knowledge of practices and protocols related to medical office procedures (i.e., medical terminology, appointments, medical records, insurance verification, cashiering, billing, etc.) | Required |
| Knowledge of ICD-9/ICD-10, CPT, and HCPCS coding sufficient to identify services performed; including diagnoses, procedures, and supplies. | Required |
| Strong oral and written communication skills to effectively communicate with patients of varying ages, diagnosis, and multicultural backgrounds. | Required |
| Bilingual skills in English and Spanish. | Preferred |
Special Requirements & Conditions
| Special Condition | Requirement |
|---|---|
| Overtime | Required |
Other Special Requirements & Conditions
|
|
Level of Supervision Received
| Supervision |
Environment
Working Environment
| Medical Center/Clinic |
Other Requirements
Items Used
|
Physical Requirements
|
Mental Requirements
|
Environmental Requirements
|
Critical Position
| Is Critical Position: Yes |