The Referrals & Authorization Specialist III is responsible to ensure that patients have been authorized for specialty services and office visits. May act as a liaison between the patient, provider/referring provider, primary care provider, and other parties involved in the plan of care. Appropriately link referrals for identified visits.
Ensure patients have been cleared for specialty services and office visits.
Obtain authorizations if needed from insurance coverage. Resolve authorization concerns prior to any patient's appointment.
Confirm insurance coverage or lack thereof for patient.
Process preauthorization forms for requesting physician office or provider.
Process patient referrals and link referrals for identified visits.
Apply clinical data/knowledge to assist patients in gaining appropriate physician, hospital, and medical referrals.
High school graduate or GED certificate is required.
A minimum of 2 years’ experience in a physician billing or third party payer environment.
Candidate must demonstrate working knowledge of contracts, insurance benefits, exclusions and other billing requirements as well as claim forms, HMOs, PPOs, Medicare, Medicaid and compliance program regulations.
Candidate must demonstrate the ability to understand and navigate the payer adjudication process.
Candidate must demonstrate a strong customer service and patient focused orientation and the ability to communicate, adapt, and respond to complex situations. Including the ability to diffuse complex situations in a calm and professional manner.
Must demonstrate effective communication skills both verbally and written.
Ability to multi-task, prioritize, and manage time effectively.
Functional proficiency in computer software skills (e.g. Microsoft Word, Excel and Outlook, E-mail, etc.)
Ability to work independently.
Requires passing a system competency assessment.
The ideal candidate is a motivated individual with a positive attitude and exceptional work ethic.