Authorization and Referral Coordinator (FT)

At Ashe Memorial Hospital, we are driven by our Mission Statement, "To meet the needs of the community by delivering patient-centered, high quality health care."

Ashe Memorial Hospital is proud to be Voted Ashe's Best Place to Work 2022, 2023 & 2024! Come be a part of our dynamic team; you'll join Ashe's 2022 & 2023 Best Hospital, Best Surgeon, Best Physician, Best Nurse, and Best Medical Practice!  This is your opportunity to make a large difference in a small community!

Hours:1st shift, Monday - Friday  | No Supervisory Responsibilities | No Travel | Pay commensurate with experience

Full time, day shift in Patient Accounting.

JOB SUMMARY:

The Authorization/Referral Coordinator is responsible for obtaining insurance benefits, verification of eligibility status and obtaining authorizations over the phone and online; collecting accurate demographics, and accurate data entry.  
The coordinator will also perform any other duties necessary to provide efficient, timely services to the patients, their families and providers. 

MINIMUM JOB QUALIFICATIONS:

Education Requirements: 

• High School graduate or Equivalent 


• Bachelor’s degree preferred 


• Knowledge of CPT coding, ICD 9 Codes, and Medicare Reimbursement issues preferred  


• Medical terminology desirable preferred 

 Experience: 

• Minimum 2 years prior healthcare office experience 

License/Certifications: 

• None 

ESSENTIAL FUNCTIONS: 

1. Completes accurate and timely insurance verification. 


2. Completes
   accurate and timely
   third party payer authorization requests, including ensuring all necessary data elements needed for an authorization (e.g., CPT codes, diagnosis codes) are available.  


3. Communicates with patients, insurers, and other appropriate parties
   pertaining to insurance verification and authorization. 


4. Reviews medical necessity and obtains additional diagnosis if applicable.
   


5. Correctly pre-registers and schedule patients.  Notifies patient of estimated liability and documents in patient’s account. 


6. Communicates clearly and appropriately to patient regarding prep for procedure,
   
   instructions upon arrival, bring photo ID, and any necessary information related to visit.  Sends out appointment notices to patient
   in a timely manner. 


7. Thoroughly interview patients or their representative to obtain/verify
   current personal information by phone for any pre-registration, referral or authorization needs. 


8. Updates and monitors charts and documents insurance approval status, number 
   
   of approved visits, and need for reassessment with licensed therapist. 


9. Scans referral and authorization to patient chart.


10. Contacts Medicare/Medicaid and obtains approval for treatment, sends in proper
    
    paperwork for these services and monitors recertification status.


11. Faxes initial evaluations to referring doctors and monitors return of signed plan of
    
    cares. 


12. Scheduling appointments over the phone if needed. 


13. Returns voicemail calls regarding scheduling appointments within 4 hours of message if needed. 


14. Provides service in a manner consistent with the safety policies. 


15. Communicates clearly and appropriately to co-workers,
    physicians and our patients. 


16. Demonstrates good organization skills. 


17. Displays a positive attitude toward work.  Contributes positively to office morale. Demonstrates a teamwork temperament with all staff. 


18. Performs other duties as assigned.
    
    
    
    
    
     

Must be willing to receive all required vaccinations (i.e., flu shot, etc.). All new employees working must be fully vaccinated as a condition of employment (unless the new hire has requested and received an exemption). Candidates for employment will be notified of this policy requirement prior to the start of employment. After receiving an offer of employment, new employees must provide proof of vaccination or request and receive an exemption before beginning work.

To apply, please fill out an application, attach a cover letter, and resume. Include gaps in employment and reasons for separation.

Criminal background check and pre-employment drug screen required upon conditional job offer.

***Benefits apply the 1st of the month following employment, per policy.***

*For full job description and benefits, please contact Human Resources.

Ashe Memorial Hospital is an equal opportunity employer and, as such, considers individuals for employment according to their abilities and performance.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the position without compromising patient care.  Employment decisions are made without regard to race, age, religion, color, sex, national origin, physical or mental disability, marital or veteran status, sexual orientation, genetic information, or any other classification protected by law. All employment requirements mandated by local, state, and federal regulations will be observed.