Provide referral and authorization management support to complex multiple physician Surgery practices in an ambulatory care setting, serving an adult patient population. Specifically supporting Surgery physicians within the following ACU’s: CSS (MIS), DF Plastics, Med Inn OMFSHD, TC Surgery(MIS). Coordinate and facilitate communications regarding authorization for surgical and outpatient clinic services among primary care physicians, managed care plans, specialists, clinic personnel, Managed Care Operations, and patients.
Additionally, this position will document bariatric surgery insurance requirements for all bariatric patients. Ensure alignment and acceptance of insurances at SJMC Hospital for Michigan Medicine patients scheduled for surgery at that facility. Obtain radiology authorizations for patients having testing done outside of Michigan Medicine.
This is a centralized role within the surgery ACU’s at Michigan Medicine and will report to the Senior Administrative Manager of the Surgery ACU’s.
Characteristic Duties and Responsibilities
Insurance verification & Authorization Duties
For all Bariatric new patients; verify insurance eligibility coverage by calling insurance company and obtaining the effective date, coverage information and patient requirements for surgery to be authorized, document this information in MiChart and update if/when insurance changes occur, serve as an insurance contact for all bariatric patients.
For SJMC cases, assist with required surgical referrals and authorizations from Medicaid, HMO, and commercial insurance providers as needed.
For SJMC cases, ensure acceptance of the insurance at SJMC and adjust cases as needed to ensure coverage.
Coordinate and facilitate on-going communication with physician’s surgery scheduler concerning patient insurance needs.
Counsel patients regarding insurance coverage and answer questions about insurance coverage when necessary.
Refer patients to Patient Financial Counselor (PFC) to discuss responsibilities or cost estimates for services past and future.
Refer patients to Patient Financial Counselor (PFC) with out-of-network insurance coverage to discuss what their financial responsibility would involve and for payment plan options with questionable insurance coverage.
For Med Inn OMFSHD assist in obtaining radiology auths for patients having radiology done outside Michigan medicine.
Referral Coordinator Duties
Obtain, process, and track insurance referrals and authorizations for all Adult DF Plastics, Adult OMFS and Adult CSS MIS patients using MiChart (EPIC).
Serve as an expert resource to staff using MiChart.
Obtain authorizations, pre-certifications and benefit level verification from third parties for scheduled appointments.
Email Call Center/Front Desk with detailed information regarding insurance issues such as insurance termed, referral/authorization not obtained in time for appointment date, waiver needed. Appointment can be rescheduled to accommodate time frame to obtain referral/authorization.
Build and maintain excellent rapport with internal and external primary care sites.
Serve as liaison between primary care physicians, specialists and patients in the referral approval process.
Serve as a resource for physicians, office staff, patients, and outside third parties for managed care authorizations and other managed care related contract issues.
Assist with patient education related to the special requirements of Managed Care Plans.
Maintain a large scope of knowledge regarding insurance plans, requirements, and expectations in an ever changing environment.
Participate in a team effort with the billing staff to work rejections, including obtaining retro referrals/authorizations and/ or having referrals/authorizations altered to meet the service rendered.
Respond to patient phone calls related to authorization concerns.
Direct patients to insurance carrier to address coverage and benefit questions related to appeals, when appropriate.
Attend quarterly referral coordinator meeting. Bring back information to share with office staff.
Act as onsite specialist to answer insurance questions from the Call Center and Front Desk staff.
Other duties as assigned.
High School Diploma or GED.
3 – 4 years of experience.
2 years of experience working in an Ambulatory Care Unit.
Knowledge of basic medical terminology.
Prior experience with patient visit or OR scheduling.
Financial counseling experience for healthcare patients.
Exceptional interpersonal skills and ability to work well within a team setting.
Demonstrates active listening, written, verbal and information technology skills.
Prior experience as a referral coordinator.
Prior experience working with a bariatric program
Knowledge of insurance requirements, referrals and authorizations and billing requirements
Knowledge of MiChart
Knowledge of Lean concepts and tools
Experience obtaining authorizations in a surgical services department
Michigan Medicine conducts background screening and pre-employment drug testing on job candidates upon acceptance of a contingent job offer and may use a third party administrator to conduct background screenings. Background screenings are performed in compliance with the Fair Credit Report Act. Pre-employment drug testing applies to all selected candidates, including new or additional faculty and staff appointments, as well as transfers from other U-M campuses.
Michigan Medicine improves the health of patients, populations and communities through excellence in education, patient care, community service, research and technology development, and through leadership activities in Michigan, nationally and internationally. Our mission is guided by our Strategic Principles and has three critical components; patient care, education and research that together enhance our contribution to society.
Job openings are posted for a minimum of seven calendar days. The review and selection process may begin as early as the eighth day after posting. This opening may be removed from posting boards and filled anytime after the minimum posting period has ended.
The University of Michigan is an equal opportunity/affirmative action employer.
Internal Number: 199192
About University of Michigan - Ann Arbor
A great university is made so by its faculty and staff, and Michigan is recognized as one of the best universities to work for in the country. The Michigan culture is known for engaging faculty and staff in all facets of the university to create a workplace that is vibrant and stimulating.For two consecutive years, the Chronicle of Higher Education has placed U-M in its "Great Colleges to Work For" survey. In particular, the university earns high marks for strong relations between faculty and administrators, a collaborative system of governance, strong pay and benefits, and a healthy work/life balance.