JOB SUMMARY

The University of Connecticut, Student Health and Wellness on the Storrs campus, is seeking a Medical Referral Coordinator and Insurance Authorization Specialist to coordinate and provide assistance in carrying out the accurate and timely pre-authorization/authorization of insurance coverage and benefits for students requiring diagnostic imaging, such as MRIs and CT scans. Provides administrative support for the insurance and billing office. This position reports to the Student Health and Wellness Insurance Specialist Manager.

SHaW is committed to diversity and inclusion, competence in working with culturally and ethnically diverse populations, and awareness of how issues of difference, power, and privilege manifest in higher education environments.  The ideal candidate promotes health equity and reduces health disparities by demonstrating and supporting an understanding, sensitivity, and appreciation for health equity, social justice, cultural humility, and inclusiveness. 

DUTIES AND RESPONSIBILITIES

1. Coordinates all aspects of the medical referral process, including coordination between SHaW providers and outside specialists as well as internal referrals from SHaW-Medical Care providers to SHaW-Mental Health providers and vice versa. Establishes and maintains relationships with area providers to expedite specialist appointments when possible. Maintains knowledge of wait times for specific specialties to manage expectations of referring providers and patients.
2. Compiles medical records, including office visit notes, laboratory results, and radiology reports for the referral, including SHaW provider clinical indications for referral. Stays up to date on record requirements for specific specialties such as endocrinology, rheumatology, orthopedics, and gastroenterology. Creates and manages communications to patients, including offering assistance in scheduling appointments with outside providers. Keeps the provider updated with patient appointment dates, ensuring timely medical care is received. Follows up with patients who have not scheduled appointments and alerts the provider as needed.
3. Works with SHaW providers to define the urgency and scope of referrals, utilizing categories of urgent, subacute, routine, and elective care. Defines timeframes for each category with provider assistance. Reviews referral process regularly to ensure efficiency. Works closely with resource RNs for assistance in the coordination of urgent and/or subacute referrals.
4. Obtains all medical records and results from specialist appointments and diagnostic imaging orders. Contacts outside offices to obtain records via phone, email, and/or fax. Notifies the provider when records are received.
5. Obtains any pre-authorizations for diagnostic imaging orders, such as MRIs and CT scans. Reviews order and confirms the CPT code accurately reflects the test ordered. Ensures the appropriate and timely processing of paperwork and/or health records; reviews for accuracy, completeness and compliance with regulations, policies and procedures; identifies and follows up to resolve problems, referring most new, unusual or difficult problems to supervisor.
6. Obtains insurance information from students and determines if authorization is necessary for the services that are needed. Confirms insurance coverage and communicates benefits to the patient. Gathers all the necessary medical information required for approval and contacts the insurance company involved. This contact may be made by phone, mail, or electronic communications, so it is important to be proficient in all modes. Offers scheduling assistance to patients as needed.
7. Communicates effectively with clinicians, insurance payers and clients to facilitate the business process and insurance/authorization process. Duties include understanding all authorization procedures and assisting clinicians in getting treatment plans to insurance companies within the guidelines of the authorization process. 
8. Works collaboratively with the clinical providers to understand medical necessity requirements and medical coding, such as CPT and ICD-10 codes.
9. Demonstrates excellent customer service skills for communicating with patients, insurance representatives and providers.
10. Provides support to the front desk team of SHaW-Medical Care and SHaW-Mental Health as needed, including answering phones and checking patients in for appointments, verifying demographic and insurance information. Also provides support to the front desk at the Sports Medicine office, servicing approximately 600 student-athletes.  
11. Responds to requests for information and assists in solving a variety of problems of ordinary difficulty, based on knowledge of the procedures, practices and experience.
12. Transmits authoritative information and serves as a resource regarding policies and procedures relating to the clinical ancillary areas and authorization administrative functions, with responsibility to occasionally interpret such policies and procedures.
13. Regularly communicates with other University offices and/or outside agencies to request or provide information or to clarify procedures.
14. Reviews operating procedures for efficiency and effectiveness; makes minor changes or recommends major changes or improvements; may participate in planning and decisions regarding new or changed procedures.
15. Devises, modifies and/or supervises the maintenance and coordination of complex filing systems, records and/or data systems which may be computerized.
16. May draft or independently compose and/or edit routine correspondence and other documents for supervisor’s review and/or signature; as delegated, signs supervisor’s name to correspondence, requisitions, vouchers, etc.; makes routine decisions in supervisor’s absence.
17. Performs routine administrative functions for the Insurance and Billing office; coordinates workflow and processes administrative paperwork. Assists with insurance and billing inquiries from patients and parents.
18. May assist in planning and carrying out related support activities, such as meetings, conferences, and interviews; makes all necessary arrangements and coordinates details.
19. Performs related duties as required.

MINIMUM QUALIFICATIONS

• Bachelor’s degree or equivalent combination of education and experience.
• Two years of experience in a medical office setting.
• Demonstrated knowledge of medical office practices, including electronic health records.
• Experience in independently resolving problems of ordinary difficulty.
• Experience coordinating administrative or clinical processes requiring detailed recordkeeping and frequent communication with healthcare providers, patients, or external organizations in a professional setting.
• Demonstrates verbal and written skills characterized by attention to detail, coherent and easy-to-follow structure, inclusion of relevant information without unnecessary repetition, and an awareness of audience and purpose.  

PREFERRED QUALIFICATIONS

• Knowledge of insurance billing and medical coding.
• Three or more years of experience in a medical office setting.
• Prior experience working in higher education or with the college-age population.

APPOINTMENT TERMS

This is a full-time, 12-month position with an anticipated start date as soon as possible.  Salary will be commensurate with qualifications and experience. Other rights, terms, and conditions of employment are contained in the collective bargaining agreement between the University of Connecticut and the University of Connecticut Professional Employees Association (UCPEA).

TERMS AND CONDITIONS OF EMPLOYMENT

Employment of the successful candidate is contingent upon the successful completion of a pre-employment criminal background check.

TO APPLY

Please apply online at https://hr.uconn.edu/jobs, Staff Positions, Search #499272 to upload a resume, cover letter, and contact information for three (3) professional references.  Incomplete applications will not be considered. 

Applicant review will begin immediately and continue until the position is filled.

All employees are subject to adherence to the State Code of Ethics which may be found at http://www.ct.gov/ethics/site/default.asp.

All members of the University of Connecticut are expected to exhibit appreciation of, and contribute to, an inclusive, respectful, and diverse environment for the University community.

The University of Connecticut aspires to create a community built on collaboration and belonging and has actively sought to create an inclusive culture within the workforce.  The success of the University is dependent on the willingness of our diverse employee and student populations to share their rich perspectives and backgrounds in a respectful manner.  This makes it essential for each member of our community to feel secure and welcomed and to thoroughly understand and believe that their ideas are respected by all.  We strongly respect each individual employee’s unique experiences and perspectives and encourage all members of the community to do the same.  All applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

The University of Connecticut is an AA/EEO Employer.