Referral and Prior Auth Coordinator
: Job Details :

McPherson Hospital -

Mission statement

Superior health care and exceptional service for each person, every time.

Vision

To be a vibrant and thriving five-star center forhealth, serving as our community's first choice for health and wellness.

Our C.A.R.E. Values

• Compassion - I will treat everyone with kindness, acceptance, empathy, and understanding.
• Accountability - I will be trustworthy, responsible, and dependable while taking ownership of my actions.
• Respect - I will value the feelings, wishes, rights, and traditions of everyone without judgment.
• Excellence - I will strive to understand and exceed the expectations of others.

Benefits

Medical / Dental / Vision

Health Savings Account

Flex Spending Account / Dependent Care Spending Account

403 (b) Retirement Plan- up to 4% employer contribution

Employer Paid Life Insurance

Employer Paid Long-Term Disability / Short-Term Disability

Earned Time Off

Free 24-hour fitness center

Job Summary:

The referral and prior auth coordinator is responsible for working with patients' insurance companies for healthcare service approvals (i.e. prescription approvals). In addition, the referral and prior auth coordinator is responsible for coordinating and facilitating internal and external referrals.

Essential Job Accountabilities:

· Department – Clinics

· Supervisor – Clinic Nurse Director

· Area of responsibility – Physician Clinics

Direct and Indirect Patient Care / Clinic Responsibilities:

· Familiarity with covermymeds website for the submission of prior authorizations requested by various insurance companies. Add all appropriate clinicians in which you will be submitting documentation on behalf of their patients.

· Submits the prior authorization request for each client assigned

· Contact review organizations and insurance companies to ensure prior approval requirements are met

· Communicates effectively with provider and/ or nursing staff when questions arise regarding patient health information pertinent to prior authorization and/ or referral

· Assemble information and provide appropriate documentation concerning patient's clinical background and referral needs to specialist

· Keeps patients/families informed of situations that affect patient's referral; i.e. appointments months out for initial consult, other options for referrals if patient is able to get in sooner with another specialist, etc.

· Maintain ongoing tracking and appropriate documentation on referrals

· Review details and expectations about the referral process with patients

· Ensure patient has correct date/ time/ location of initial appointment with specialist in which they are referred

· Request documentation from initial consult appointment with specialist

· Assists with patient education based on assessment of patient needs and clinic standards of nursing care and documents in patient record

· Assumes role of advocate to ensure health needs are met including responding to patientphone messages and requests in a timely and professional manner

· Documents all nursing actions, and interventions on patient record consistent with organizational policies

· Knowledgeable of and follows all established Infection Control guidelines and OSHAstandards and participates in staff training events

· Able to perform effectively and appropriately in emergency situations

· Performs other duties as assigned or requested

Position Responsibilities:

· Consistent patient centered care

· Knowledgeable of the scope of practice for all nursing disciplines as described by the Nursing Practice Act

· Demonstrates the ability to effectively organize and prioritize work and utilize available resources to assist with efficient patient flow in the clinic

· Utilizes the health center Performance Improvement processes in identifying the centerneeds related to any aspect of patient care and customer service

· Demonstrates flexibility in work roles and schedules to meet the changing needs of thecenter

· Maintains awareness of new information applicable to job, i.e. policies, meeting minutes,procedures, memos, and protocols

· Utilizes slow time constructively to enhance center operations and assists otherdepartments when time and workload permits

· Maintains professional appearance; follows established dress code

· Promptly informs supervisor of real or potential clinic problems

· Maintains confidentiality of patients and staff

· Ability to identify own areas of needed improvement and formulates goals to worktoward.

· Utilizes appropriate methods to deal with stressful situations

· Understands and supports organizational goals

· Meets work schedules, fulfills responsibilities and commitments, i.e. attendance,punctuality, dependability, initiative, productivity and efficiency.

QUALIFICATIONS:

Education: Minimum Required: Completion of a LPN / LVN accredited program

Experience:

Minimum Required: Minimal/No Experience

Preferred: One to two years of experience

Skills:

o Good communication skills

o Good organizational and time management skills

o Computer skills related to word and outlook

o Strong customer service

o Effective verbal and written communication skills

o Teamwork orientation

o Critical thinking and problem-solving skills

Licensure/Certification:

· Current LPN license in the state of Kansas

BLS verification within 6 months of hiring

We are an equal opportunity employer and prohibit discrimination/harassment without regard to race, color, religion, age, sex, national origin, disability, status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.