Prior Authorization and Referral Specialist

About Us La Plata Family Medicine, a cornerstone of healthcare in the picturesque mountain town of Durango, Colorado, has been a beacon of exceptional healthcare for over 39 years. As a private, outpatient-only family practice, we have proudly served the Four Corners community since the 1980s. Our mission is to provide unsurpassed primary health care, integrating the highest quality medical care with specialty resources and strong patient advocacy. We are committed to being accessible, compassionate, and respectful to our diverse patient population, focusing on their physical, psychological, and spiritual well-being. At La Plata Family Medicine, we don't just treat patients; we care for individuals Position Overview The Prior Authorization and Referral Specialist is responsible for obtaining authorizations for all patients with orders that require pre-authorization and coordinating and sending referrals to specialists. The employee will maintain a professional working atmosphere and provide excellent customer service to all patients, the general public, co-workers, physicians and provider representatives.

Responsibilities:

Coordinate all aspects of patient referrals, including scheduling appointments with specialists and arranging necessary diagnostic tests. Obtain pre-authorization from insurance companies for procedures and specialist visits as required. Maintain accurate and up-to-date records of all referrals in the electronic medical records system; track pending referrals and follow-up to ensure timely patient care. Serve as a liaison between patients, primary care providers, specialists, and insurance companies; ensure effective communication of medical information and patient needs. Verify patient insurance coverage and understand policy requirements related to referrals and specialist visits; communicate with insurance companies to resolve issues. Assist patients in understanding the referral process and provide them with relevant information about the specialist or facility they are referred to. Adhere to healthcare regulations, including HIPAA, and continuously evaluate and improve the referral process for enhanced patient care and efficiency. Performs other job-related duties as assigned

Supervisory Responsibilities:

None Qualifications:

High School Diploma or equivalent Must have experience working with health insurances, either through medical billing or medical reception, or HR benefit management. Must be familiar with medical terminology. Must have computer experience and the ability to learn new programs. Must embrace electronic solutions over paper. Must have experience with data entry and the ability to enter data quickly and accurately. Must have excellent organizational skills. Must have the ability to multi-task. Must have excellent communication and customer service skills. Must demonstrate teamwork, flexibility, and a willingness to adopt new work methods.

Pay:

$18.00 - $18.50 per hour

Benefits:

401(k) 401(k) matching Dental insurance Employee assistance program Health insurance Paid time off Vision insurance Application Question(s): Are you within a commutable distance to the office in Durango, Colorado?

Education:

High school or equivalent (Preferred)

Experience:

healthcare setting: 1 year (Preferred) medical insurance: 1 year (Preferred)

Work Location:

In person