Referral and Prior Authorization Coordinator - HYBRID

Non-Exempt hybrid position (two days in the office, three days from home). In-office training required for 6–9 months; must perform all essential job functions before transitioning to hybrid schedule.

About the role

CNY Family Care, LLP was founded in 1999 with the goal of providing compassionate and professional medical care. We are a family-oriented medical practice with physicians, physician assistants, nurse practitioners, and diabetic educators. CNY Family Care takes a team approach to meeting the medical needs of our patients through compassion, respect, and professional care. We partner with patients to provide a proactive approach that improves their quality of life. One of our main goals is to provide continuous and comprehensive health care; patients select a personal physician who oversees their care team.

Responsibilities

• Verify patient insurance benefits, eligibility, and demographic information accurately for corresponding referral.
• Communicate with patients, providers, clinical staff, and insurance companies to ensure timely and accurate processing of referrals.
• Complete required specialist referral forms and ensure documentation and orders are accurate and complete.
• Read and understand medical terminology and decipher different document types within the Electronic Medical Record (EMR).
• Work independently, use critical thinking to problem-solve with minimal supervision, identify gaps in documentation, and take corrective actions.
• Obtain necessary authorizations and pre-certifications for specialist visits and advanced medical imaging.
• Submit, obtain, and track insurance authorizations.
• Maintain a detailed record of all referral activities and follow-up actions in the EMR.
• Send appropriate medical record documentation to the correct insurance carrier via fax or online authorization website.
• Send appropriate referral documentation to the correct provider using the EMR.
• Follow up on referrals by generating reports in Medent to ensure timely follow-up per CNY Family Care policies and procedures.
• Verify appointments and corresponding documentation is attached to close out referrals.
• Contact other physician offices to obtain any missing documentation or consult reports needed.
• Utilize local RHIO and Community Chart in Medent to obtain documents from other providers and facilities as needed to close open referrals.
• Generate patient correspondence regarding non-compliance with recommended treatment by outside providers/treatment facilities to ensure appropriate follow-through documentation in the patient record.

Requirements

• High school diploma or general education degree (GED) required; one to two years of college preferred.
• RHIT preferred.
• Two years of experience working in a health care setting required.
• Experience in prior authorizations, insurance verification, or medical billing helpful.
• Previous experience using an electronic medical record (EMR) system required; Medent EMR experience highly prioritized.
• Knowledge of medical terminology.

Benefits

• Annual performance review with performance-based merit increase.
• Health, dental, and vision benefits available with coverage effective the first of the month following date of hire.
• Full complement of voluntary benefits.
• $1,000 annual employer HSA contribution for employees enrolled in CNYFC high-deductible health plan.
• Free office visits with NP or PA for employees who are patients of the practice and enrolled in CNYFC high-deductible health plan.
• Waiver program for health benefits ($3,000 annually).
• 401K after six months with up to 7% combined employer match and annual discretionary profit-sharing contribution.
• Generous paid time-off that increases with years of service.
• 8 paid holidays per year; closed on major holidays.
• Free onsite parking.
• Free lunch daily.

Pay

$17.75 – $26.00 per hour, depending on experience, licensing, and education.

Schedule

Full-time, Monday – Friday, days.