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Referrals and Authorization Health Plan Coordinator

Company: OHSU Health Hillsboro Medical Center
Location: Hillsboro
Posted on: May 3, 2021

Job Description:


The Health Plan Coordinator is responsible for maintaining patient referral and authorization requirement needs through guidelines established by the patient’s individual insurance plans.

The work environment is a combination of multi-line telephone use, insurance hub, receptionist and scheduling coordination. It could involve assisting with the check-in and checkout processes. Gathers and records required information about referrals and authorizations for services, and routes it appropriately; provides specific customer services which include, confirming health insurance coverage and individuals obligations, obtaining necessary authorizations for care, scheduling appointments or procedures, and assisting patients in an office or clinic setting.?Requires out of the box thinking, strong ability to multi-task and above all else, exceptional customer service skills. 



Performed majority of the time -- please start with the responsibilities that are the most time consuming:

·       Processes referrals and authorizations as indicated by the various insurance plans, for consultations, studies and procedures.

·       Obtains authorization for medications with insurance companies as needed, both prescription and infusion medications.

·       If applicable, coordinates the sample medication program within the clinic which includes:  receiving medication, updating and reconciling the medication log, providing appropriate drug documentation to providers (MD's should be providing this with med to patient), and ensure appropriate inventory levels for samples.  Position will also oversee the medication storage within the clinic which includes ensuring medications are stored in a secured fashion and not accessible to anyone not authorized to handle medications, oversee temperature settings for medication fridge, and will work with pharmacy to conduct monthly medication management surveys.

·       Works with patients to find co pay and drug assistance.

·       Prepares and routes medical information to third parties and referral physicians with proper authorization and notation.

·       Maintains appropriate notations and copies of documents in patient charts.

·       Responds to requests for status of referrals. 

·       Verifies insurance eligibility for physician visits.

·       Answers and follows-up on telephone inquiries; directs callers to other providers, staff or departments when appropriate. Triages and documents accurately telephone calls from patients including requests for medication refills, complaints, general information inquiries, and urgent health care concerns. Delivers such information or requests promptly to the appropriate providers or their designees.

·       Obtains prior medical records and studies as appropriate

·       Updates demographic records for patients, entering all information from patients directly into computer in a concise and professional manner.

·       Updates financial record for customers, entering all information from patients directly into computer in a concise and professional manner regarding patient concerns, questions and agreements regarding their bill statements, payments and insurance information.

·       Responds to correspondence as appropriate, by phone or in writing.

·       Collects, sorts and distributes mail daily.

·       Responds to correspondence as appropriate, by telephone and/or in writing.

·       Maintains an organized work area.

Performed occasionally but critical to successful performance of the job:

·       Checks in patients to include gathering patient information, entering into computer, collecting co-payments, creating new charts and handles insurance information appropriately.

·       Checks out patients to include addressing any additional patient concerns or needs.

·       Schedules patient correctly through EMR and within provider guidelines.

·       Attends monthly full staff meeting.

·       Communicates supply needs in a timely manner to the ordering person.

·       Attends insurance workshops and reads insurance updates.

·       Completes all mandatory education and licensure requirements to meet state, professional and regulatory requirements.

Decision making and budget responsibilities (e.g. impact limited to the employee, entire unit or organization-wide):

·       Impact limited to the employee.

·       No budget responsibility.

Assigned direct reports (not limited to the ones listed). If not applicable, please enter N/A:

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·       High school graduate or GED.




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Licenses, Certifications and/or Registrations:


·     N/A



·       Current BLS certification.


Job Related Skills, Abilities and Behaviors:


·       Demonstrates professional appearance and personal conduct for the employee's particular job.

·       Uses effective communication skills taking into consideration body language, filters, listening, paraphrasing, and questions with customers of diverse ethnic and cultural backgrounds.

·       Excellent grammar, spelling and mathematics abilities.

·       Demonstrates excellent telephone skills and customer service skills.

·       Demonstrates effective organization skills and ability to multitask with frequent interruptions.

·       Demonstrates working knowledge and understanding of medical terminology and insurance authorization processes, CPT and ICD-10 CM coding methodology.

·       Demonstrates knowledge of managed care insurance plan requirements.

·       Understands and applies insurance coverage pertaining to co-payments, referrals.

·       Demonstrates personal computer skills including working knowledge of Word and Excel programs.

·       Demonstrates confidentiality in dealing with patients, patient families and co-workers.

·       Models effective working relationships with all health care and insurance plan representatives.

·       Practices confidentiality regarding staff, department and organizational issues.



·       Bilingual in Spanish and English.




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OHSU Health Hillsboro Medical Center, formerly Tuality Healthcare has always been committed to our community. It's a part of how we care for each other, and part of what makes this place different.


We had a humble start in 1918 when an enterprising woman named Minnie Jones Coy started a small six-bed hospital in her Hillsboro home. She brought together independent physicians under one roof to treat the sick and provide a safe place for mothers to give birth. A century after Minnie made her commitment to the people of Hillsboro, her vision continues as we provide world-class health care to patients.


As part of our affiliation with OHSU Health, we’ve changed our name to Hillsboro Medical Center. This new moniker reflects our expanded services and clinic locations that provide patients living in Hillsboro and western Washington County greater access to primary and specialty care.

Hillsboro Medical Center believes in providing equal employment opportunities for all qualified individuals. Recruitment, hiring, promotions, transfers, working conditions, training, and compensation will be based on qualifications without regard to race, color, sex, sexual orientation, gender identity, religion, age, creed, national origin, marital status, family relationship, veteran status, genetic information, physical or mental disability, or any other status or characteristic protected by applicable law. We further commit ourselves to continuing the practical application of this policy in our daily business conduct.

Keywords: OHSU Health Hillsboro Medical Center, Hillsboro , Referrals and Authorization Health Plan Coordinator, Other , Hillsboro, Oregon

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