Referral and Authorization Coordinator - Access

ABOUT MARINHEALTH
Are you looking for a place where you are empowered to bring innovation to reality? Join MarinHealth, an integrated, independent healthcare system with deep roots throughout the North Bay. With a world-class physician and clinical team, an affiliation with UCSF Health, an ever-expanding network of clinics, and a new state-of-the-art hospital, MarinHealth is growing quickly. MarinHealth comprises MarinHealth Medical Center, a 327-bed hospital in Greenbrae, and 55 primary care and specialty clinics in Marin, Sonoma, and Napa Counties. We attract healthcare’s most talented trailblazers who appreciate having the best of both worlds: the pioneering medicine of an academic medical center combined with an independent hospital's personalized, caring touch. 

MarinHealth is already realizing the benefits of impressive growth and has consistently earned high praise and accolades, including being Named One of the Top 250 Hospitals Nationwide by Healthgrades, receiving a 5-star Ranking for Overall Hospital Quality from the Centers for Medicare and Medicaid Services, and being named the Best Hospital in San Francisco/Marin by Bay Area Parent, among others. 

Company:

Prima Medical Foundation dba MarinHealth Medical Network

Work Shift:

Day Shift (United States of America)

Scheduled Weekly Hours:

40

Job Description Summary:

The Referral and Authorizations Coordinator provides medical administration support to providers by obtaining referral or prior authorizations for patients to see specialty providers. Serves as a resource to providers, clinic leaders, and the Patient Access Department regarding the referral and authorization process.

Job Requirements, Prerequisites and Essential Functions:

Pay Range:

$22.50 - $27.00 - $34.00

Essential Functions and Responsibilities: 

• Accurately processes referrals requests and obtains necessary authorizations in compliance with Referral Management Program.
• Closely collaborates with physician office staff to ensure accuracy, timely handling, and appropriate scheduling of referral appointments within the correct departments.
• Maintains positive working relationships with payer representatives including Managed Care, processes authorization and referral requests for members in coordination with health plans and contracted providers.
• Utilizes critical thinking and attention to detail to communicate with patients in their preferred method through either online secure messaging, telephone, or in writing throughout the referral process to ensure that services are rendered.
• For R&A Coordinators who are also Medical Assistants (MAs): Communication and correspondence may include lab results and prescription management.
• Complies with HIPAA and confidentiality policies and procedures.
• Supports completion of work queue items; referral processing, registration and insurance verification activities.
• Establishes & maintains a collaborative working relationship with providers & Patient Access staff to ensure smooth record flow and the provision of high-quality services at all times.
• Arranges and maintain medical records to ensure proper order and easy retrieval, and maintain confidentiality and security of records.
• Supports HIM as necessary to scan documentations of lab results, hospitalizations and discharge forms, and other documents pertaining to the patient or requested appointment.
• Ensures that all work meets quality standards and is completed in a timely manner.
• Perform other duties as assigned.

Continuous Improvement:

• Supports the implementation of programs, policies, initiatives, and tools.
• Contributes ideas and actions towards the continuous improvement of Patient Access related processes within area of influence.

People Development:

• Adaptable to learning new processes, concepts, and skills.
• Seeks and responds to regular performance feedback from team lead; provides upward feedback as needed.

Relationship Management:

• Maintains positive work relationships with members of other teams to communicate effectively and to ensure compliance with cross-team responsibilities.
• Assists in ensuring efforts of the team to support building strong peer-to-peer relationships.

Patient Satisfaction:

• Performs revenue cycle tasks necessary to ensure compliance and exceptional customer service.
• Authenticates patient identity throughout all processes.
• May provide directional support to patients and/or family members.
• Maintains knowledge of applicable Federal, State, and local laws and regulations, C.A.R.E.S. as well as MarinHealth policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior.

Qualifications:

Education:

High school diploma or General Educational Development (GED) certificate required.  

Experience:

Preferred Experience As Typically Acquired In:

• 2 years of experience working in a health care setting
• 2 years of experience working with insurance prior authorizations, referrals and working with electronic health record

Specific Skills And Knowledge

• Medical terminology, Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS)/International Classification of Diseases (ICD)-9 coding knowledge.
• Knowledge of medical terminology/anatomy.
• Ability to exercise discretion and make independent judgements, seeking review when decisions represent significant departure from established guidelines.
• Knowledge of Microsoft Office programs including Excel, Word or similar programs.
• Ability to maintain composure during challenging interpersonal interactions.
• Active listening skills; including interpersonal skills and telephone communication.
• Organizational skills with attention to detail and follow-up.
• Epic and/or APeX experience preferred

General Skills And Knowledge

• General knowledge of patient access, financial counseling, and ambulatory settings.
• Working knowledge and understanding of insurance and medical terminology.
• Emergency Medical Treatment and Active Labor Act (EMTALA) and Consent Laws knowledge.
• Time management skills and the ability to manage frequent in-person patient contacts while effective maintaining and documenting data in the patient registration systems.
• Demonstrated ability to work in multiple computer systems, such as patient registration/accounting systems, telephone consoles, document imaging, scanning, payment posting, proprietary payer websites and data quality monitoring, both accurately and efficiently.
• Possess verbal and written communication and active listening skills.
• Accuracy and attentiveness to detail.
• Decision making and problem-solving skills.
• Must be able to work concurrently on a variety of tasks/projects in diverse environment.
• Ability to meet or exceed targeted customer service, productivity and quality standards.
• Computer proficiency skills.
• Requires the ability to work with and maintain confidential information.

Accommodation:

Qualified applicants with disabilities may request reasonable accommodation during the application process by contacting Human Resources at 415-925-7040 or [email protected].

C.A.R.E.S. Standards:

MarinHealth seeks candidates ready to model our C.A.R.E.S. standards—Communication, Accountability, Respect, Excellence, Safety—which foster a healing, trust-based environment for patients and colleagues.

Health & Immunizations:

To protect employees, patients, and our community, MarinHealth requires measles, mumps, varicella, and annual influenza immunizations as a condition of employment (and annually thereafter). COVID-19 vaccination/booster remains strongly recommended. Medical or religious exemptions will be considered consistent with applicable law.

Compensation:

The posted pay range complies with applicable law and reflects what we reasonably expect to pay for this role. Individual pay is set by skills, experience, qualifications, and internal/market equity, consistent with MarinHealth’s compensation philosophy. Positions covered by collective bargaining agreements are governed by those agreements.

Equal Employment:

All qualified applicants will receive consideration for employment without regard to race, color, religion, national origin, sexual orientation, gender identity, protected veteran status or disability status, and any other classifications protected by federal, state, and local laws.