Referral & Authorization Coordinator

Job not on LinkedIn

🔥 1 hour ago

🚗 Michigan – Remote

🚗 Michigan – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

👻 Ghost score 12%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Wayne State University Physician Group (UPG)

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2000

🏥 Healthcare

🤝 Non-profit

📚 Education

Healthcare • Non-profit • Education

Wayne State University Physician Group (UPG) is a non-profit, multi-specialty academic group practice headquartered in Detroit that provides comprehensive primary and specialty medical care across southeastern Michigan. With over 400 physicians and advanced practice providers in roughly 50 specialties, the organization offers clinical care, medical education, and clinical research through affiliated Wayne State University School of Medicine programs. Wayne State UPG operates multi- and single-specialty clinics, mobile health units, and community-focused programs like the Center for Population Health Accountability to address medical, behavioral, and social determinants of health.

📋 Description

• Obtain pre-certifications and pre-authorizations for procedures and specialist referral appointments • Schedule outpatient testing with other providers for Wayne Health • Coordinate, document and process medical referrals and prior authorizations requested by clinic providers • Answer incoming calls from patients and the public • Schedule appointments for imaging, diagnostic services, and new and returning patients • Make follow-up phone calls and address complaints • Troubleshoot problems and provide information to patients and the public • Process referrals and submit medical records to insurance carriers • Verify patient insurance eligibility and benefits • Request, track, follow up on and secure authorizations before services • Manage referral repositories including EHR buckets, provider email, faxes, Auth inbox and Teams message groups • Document and communicate patient correspondence and messages in the EMR • Apply ICD10 and CPT code knowledge • Achieve productivity and quality metrics • Review authorization information for accuracy and completeness • Prioritize authorizations by patient urgency • Update patient insurance, contact details and demographics in the EHR • Monitor insurance changes affecting coverage and authorization requirements • Support appeals for denied authorizations • Update patient information and registration • Respond to patient inquiries by phone and email • Research information using available resources • Resolve and escalate patient complaints and urgent or emergent questions • Route calls to appropriate resources • Follow up with patients and callers within departmental timeframes • Document communications according to standard operating procedures • Answer Wayne Health calls and contribute to team operations

🎯 Requirements

• High School Diploma or equivalent required • Minimum 2-3 years insurance, medical prior authorization, billing or Physician Office experience • Working knowledge of ICD10 and CPT Codes • Able to operate and stay organized when using multiple computer screens and website windows • Proficiency in Microsoft Outlook, Teams, Word and Excel • Intermediate medical terminology • Basic office skills including typing 35 wpm and accurately enter alpha numeric data • Possess excellent verbal, written communication and problem-solving skills • Excellent interpersonal skills necessary to establish and maintain productive working relationships with physicians, patients and their families and other people both inside and outside the clinical practice area • Excellent customer service skills including the ability to use independent thinking, sound judgement and creativity when resolving customer issues or concerns • Attention to detail in documentation and communication • Ability to effectively work independently and with a team • Manage multiple tasks with shifting priorities • Knowledge of medical insurance and medical office billing • Proficient in navigating EHR, Nextgen or Athena system preferred • Ability to stand/sit for long periods of times and lift up to 50 pounds • Requires sensitivity to work with seriously ill patients and their families • Compliance with Department Health and Safety policies and procedures

🏖️ Benefits

• Full-time, 40 hour work week • Additional hours may be required • EEO/AA/Veteran/Disability Employer