Authorization & Referral Specialist

Description

THIS IS AN ON-SITE POSITION.

PURPOSE STATEMENT

Verify and obtain authorizations as required by insurance company’s dependent upon the plan coverage for all patients. Complete registration and scheduling for sleep center including sleep studies and clinic visits.

ESSENTIAL FUNCTIONS

• Excellent interpersonal skills required to communicate with Care Team and funding sources.
• Possess excellent time management and organizational skills.
• Demonstrate critical thinking, creativity, problem solving and decision-making skills.
• Working knowledge of federal, state, local and intermediary specific billing requirements to ensure appropriate authorizations are complete and/or notifies appropriate person of missing or incomplete billing requirements and follows up in a timely manner.
• Assist in educating and act as a resource to the Care Team regarding authorizations.
• Assure all pre-authorizations have been approved with the proper procedure code prior to service being rendered.
• Knowledgeable of current changes in coding and reimbursement requirements for all billing payors.
• Contact providers with authorization, denial and appeals process information.
• Research and work with patient success and billing departments in researching and resolving rejected, incorrectly paid or denied claims as requested.
• Greet patients and visitors in a courteous and friendly manner.
• Demonstrate ability to deal effectively with emotionally charged situations.
• Perform insurance verifications on a daily basis.
• Ensure that all necessary documentation is completed prior to obtaining authorization.
• Ensure that all documentation required for authorization is obtained and forwarded to proper entity.
• Close the referral loop by ensuring all necessary documentation has been received.
• Schedule patients for sleep studies once authorization is obtained.
• Work from referral pool to schedule visits in the clinic.
• Register all sleep center patients.
• Maintain regular and predictable attendance.
• Perform other essential duties as assigned.

Requirements

EDUCATION/EXPERIENCE/SKILL REQUIREMENTS 

• High school diploma or equivalent.
• Minimum two years’ general office work experience is preferred.
• Computer and EMR experience.
• Medical terminology-preferred.
• Organizational skills.
• Advanced typing skills.
• Communicate well with people both in personal contact and in telephone conversations.
• Effectively act as a liaison between patient and provider.
• Follow oral and written instructions.
• Familiar with medical office practices and medical insurance.
• Familiar with ICD-10, CPT, HCPCS codes.
• Must be self-motivated and have the ability to work within the established policies, procedures and practices prescribed by the hospital/clinic.

PHYSICAL/MENTAL REQUIREMENTS 

• Must be able to sit and stand, intermittent 8 to 10 hours a day.
• Must be able to use standard office equipment, including the telephone and computer keyboard.
• Continuously works under pressure of near 100% accuracy while meeting inflexible deadlines.
• Continuously utilizes manual/bi-manual dexterity, near vision, speech, and hearing.
• Frequently stands, walks, sits and utilizes eye/hand coordination and color definition.
• Occasionally reaches above shoulder, regularly required to lift and/or carry up to 40 lbs.
• Occasionally walks on uneven surfaces.