Referral Coordinator, Prior Authorization & Managed Care
Overview
You own the referral and prior authorization process for patients at Sutter Health's SF Spine clinic, coordinating with health plans and specialty providers. You work closely with providers and Case Management staff to ensure accurate, timely authorizations. This role is central to patient access to care, with a focus on Managed Care workflows. You operate with minimal supervision, serving as a key resource for the authorization process.
What You'll Do8
- 1Obtain referrals and prior authorizations for patients to see specialty providers, ensuring accuracy and consistency.
- 2Process authorization and referral requests for members in coordination with health plans and contracted providers.
- 3Serve as a resource to providers regarding the authorization process, answering questions and guiding on requirements.
- 4Support Case Management staff with administrative tasks related to referrals and authorizations.
- 5Track and follow up on pending authorizations to prevent delays in patient care.
- 6Document all interactions and authorizations in the electronic health record system.
- 7Collaborate with insurance companies to resolve authorization denials or issues.
- 8Maintain up-to-date knowledge of Medicare, Medi-Cal, and other payer requirements.
Requirements8
- 12+ years recent relevant experience in medical administration, referral coordination, or prior authorization.
- 2HS Diploma or GED required.
- 3Proficiency with electronic health records and authorization systems.
- 4Knowledge of Managed Care plans and referral processes.
- 5Strong communication skills for interacting with providers, patients, and insurance companies.
- 6Ability to work independently with minimal supervision.
- 7Familiarity with CPT and ICD-10 codes is a plus.
- 8Detail-oriented with strong organizational skills.
Salary Insight
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