Referrals and Authorizations (Patient Representative, Level 3)

Job Title: Referrals and Authorization (Patient Representative, Level 3)

Job Family: Business Support

Department: Patient Services

Reports to: Patient Services Manager

Classification: Non-Exempt

Status: Full Time

OUR MISSION

We pursue excellence in the delivery of professional, compassionate, and complete eye care.

OUR VALUES

• Empathy | Understand others’ feelings and perspectives.
• Extend Grace | Show kindness, compassion, and understanding.
• Desire to Help People in Need | Strong sense of social responsibility.
• Desire to Work | Perform your job to the best of your abilities.
• Invest in Yourself | Never stop learning.
• Benefit of the Doubt | Foster positive relationships and interactions.

POSITION SUMMARY

A successful Patient Representative (PR) is responsible for supporting and safeguarding Fogg Remington EyeCare (FRE) Standard of Patient Care. As a PR, you will juggle multi-tasks simultaneously and regularly complete ad hoc projects. The workday goes by quickly, and no two days are exactly alike. The PR should be committed to the Company’s strong learning culture and creating a positive patient experience. They play a vital role in helping to create a positive experience during their visit. The Patient Representative, Level 3 – Referrals and Authorization position is responsible for the timely and successful processing of referrals from area providers, verifying accuracy of all clinical and insurance information, and obtaining authorization for procedures. They also assist patients in answering questions regarding insurance benefits, scheduling logistics, and address any concerns or questions.

ESSENTIAL FUNCTIONS, DUTIES, and RESPONSIBILITIES

• Coordinates and processes all incoming referrals to ensure timely patient care.
• Obtains and organizes all necessary information from the patient medical record as needed.
• Verifies insurance information, checks eligibility and obtains authorization as required.
• Ensures all insurance information is accurate and current, including adding/updating insurance to patient medical record.
• Ensures timely communication with patients to schedule for appointment(s) with providers.
• Acts as a primary point of contact and maintains positive and professional working relationships with referring physicians/office staff.
• Communicates effectively with internal team members to ensure accuracy in clinical information, and timely and accurate processing of claims. Works collaboratively to identify process improvements when needed.
• Stays current on trends in insurance plans and eligibility and authorization requirements.
• Ensure timely and accurate scanning, documentation, and record-keeping (e.g., notes) of all relevant paperwork and activities in the patient medical record performed as part of the referral and authorization process.
• Cross-train in relevant/related functions and roles as necessary, and assist/train other staff in related functions as needed.
• Has not been sanctioned or excluded from participation in federal or state healthcare programs by a federal or state law enforcement, regulatory, or licensing agency.
• Maintain confidentiality by safeguarding ePHI and demonstrating HIPAA compliance to our patients.
• Ensure that HIPAA privacy policies are clearly understood and followed.
• Present a positive view of FRE to the community.
• Protect company assets.
• Support all co-workers and treat them with dignity and respect.
• Support the team to reach common goals.
• Be able to think and act quickly and efficiently in emergencies.
• May drive on company business.
• Must have valid California driver’s license (required).
• Comply with all FRE policies and procedures, including but not limited to workplace safety, reporting work-related injuries, Infection Control, and preventing potential safety risks for staff, clients, and others.
• Punctual and regular attendance is an essential responsibility of each employee at FRE. Employees are expected to report to work as scheduled, on time, and prepared to start working. Employees also are expected to remain at work for their entire work schedule. Late arrival, early departure, or other absences from scheduled hours are disruptive and must be avoided.
• Other duties as assigned. Please note that this job description is not designated to cover or contain a comprehensive listing of activities, duties, or responsibilities required for the employee. Duties, responsibilities, and activities may change at any time, with or without notice.

EDUCATION AND EXPERIENCE
Education

• Required: Possession of a high school diploma or GED.
• Preferred: Successful completion of a Medical Assistant or comparable program.

Experience

• 2-3 years of experience working with medical referrals and authorizations, medical billing, or comparable experience.

KNOWLEDGE, SKILLS, and ABILITIES

• Recognize and comprehend basic medical terminology.
• Have a fundamental understanding of both medical and vision insurance.
• Good interpersonal skills and the ability to communicate effectively with different audiences.
• Intermediate to advanced phone skills; able to effectively relate via the telephone and in-person to serve the needs of Clinic patients/clients/visitors in an efficient and productive manner.
• Strong written and verbal communication.
• Ability to gracefully assist unhappy customers.
• Ability to interact and work effectively with co-workers, clients, guests, volunteers, and others.
• Well-spoken and polished demeanor.
• Cultural sensitivity and demonstrated ability to work with diverse people groups.
• Attention to detail requires a high level of accuracy and attention.
• Time management and organizational skills: Prioritizing tasks, meeting deadlines, and staying organized.
• Problem-solving skills: Analyzing complex problems, developing creative solutions, and making sound decisions.
• Proficiency with Microsoft 365 (Microsoft Word/Excel/Outlook).

WORK ACTIVITIES, STYLES, and REQUIREMENTS

FRE Standards of Patient Care

• Respect: Treat all patients with respect and dignity.
• Communication: Communicate clearly and effectively with patients and their families.
• Safety: Ensure the safety of all patients and staff.
• Quality: Provide quality care and services to all patients.
• Privacy: Respect the privacy of all patients and their families.
• Accessibility: Ensure all patients can access the care and services they need.

Environmental Conditions

• Indoors in a typical office environment approximately ninety-five percent (95%) of the time.
• Frequent computer use at the workstation for up to eight hours.
• Frequently work at a fast pace with unscheduled interruptions.
• May occasionally move (walk or drive) from one work location to another.

Physical Demands

• Use one or two hands to grasp, move, handle, control, feel, and assemble objects, tools, or controls.
• Use fingers to grasp, move, or assemble very small objects.
• Ability to walk, sit, stand, stoop, crouch, and climb stairs.
• Ability to move and lift up to 10 pounds.
• See the differences between colors, shades, and brightness.
• Visual acuity (Far/Near).
• Regular and consistent attendance.