This position is a liaison between White Bird Medical Clinic and specialty clinics, pharmacies, DME suppliers, insurance companies, and other outside agencies. The objective of the position is to facilitate care coordination, provide robust documentation, and act as a problem solving point person in external agency processes. The referral and insurance specialist is responsible for processing and following up on referrals, processing prior authorizations for prescriptions and DME orders, dealing with prescription and insurance issues, fulfilling medical records requests, and performing other clerical operations related to clinical care as needed.
1. Process all referrals, including creating referral sheets with all relevant information, sending corresponding records, following up on referral process with external offices and documenting appropriately.
2. Process prior authorization requests for medications and DME, including ordering DME from suppliers, and documenting appropriately.
3. Resolve insurance problems that arise between the clinic, the insurance companies, and/or specialty providers as needed.
4. Resolve insurance related issues with pharmacies and/or patient prescription issues.
5. Copy and send patient records for billing purposes, to specialty clinics we refer to, and to fulfill medical records requests from outside agencies.
6. Send invoices to appropriate agencies for medical records requests.
7. Continuously monitor incoming faxes, distribute faxes to appropriate staff and upload documents into EHR charts.
8. Attend weekly staff meetings as directed as well as additional meetings as scheduled.
1. One year medical and/or dental office experience
2. One year experience working with the referral and prior authorization process
3. Ability to work with a diverse population and a broad range of situations while maintaining a professional and courteous attitude
4. Strong computer skills: Word / Excel / Internet (Firefox) / NextGen EPM & EHR
5. Strong math and English language skills
6. Detail oriented. Ability to work independently and to a deadline.
7. Strong communication skills
8. Complete new employee orientation
9. A SENSE OF HUMOR!!
1. Completion of college level MOA (Medical Office Assistant) training.
2. Knowledge of local medical community and systems
3. Bilingual in English and Spanish preferred
4. Experience in working in a consensus environment
Accountability: This position reports to the Office Manager.
NOTE: All positions at White Bird Clinic have a minimum 3 month probationary period.