Job Description
Job DescriptionReferral Authorization Specialist
General Job Summary: The Referral Authorization Specialist will be responsible for managing referrals from the practice to other facilities or service providers and incoming action referrals from other service providers.
(This is a full time position that will support the TPC at SouthPark, Monday to Friday 8 am to 5 pm)
Primary Job Responsibilities:
- Complete all referrals for the clinics and ensure they are processed effectively, making sure they are sent to the correct department.
- Responsible for prioritizing Stat Referral Authorizations.
- Follow up on sent referrals.
- Review patient benefits and eligibility to communicate with clinician and clinical staff pertaining to authorization.
- Keep the system up to date with any changes in information.
- Manage referral status to ensure clinics have all updated and current information.
- Completes referrals for patients and coordinates with referring and receiving practices and/or departments.
- Obtains and maintain prior authorizations for diagnostic and ancillary testing.
- Handle sensitive information in a confidential manner.
- All other duties as assigned.
Clinic Support responsibilities include:
- Compiles patients’ health information including patient symptoms and medical history, exam results, X-ray reports, lab tests, diagnoses, and treatment plans.
- Ensures all related reports, labs and demographics are sent to the outside facility prior to their appointment.
- Reviews to ensure all forms are completed, properly identified, and signed and that all necessary information in the EHR.
- Communicates as needed with physicians and other health care professionals to clarify diagnoses or obtain additional information.
- Obtains lab/X-ray reports, hospital notes, referral information, etc.;
- Verifies insurance coverage and patient demographics;
- Updates charts to ensure that information is complete and filed appropriately.
- Ensures timely delivery of outside mail and communication to the physician
Requirements:
Education, Experience and Certifications:
- High School Diploma or GED required.
- Minimum 2 years’ experience in a health coordination role.
- Demonstrated understanding of industry guidelines and best practices.
- Thorough understanding of insurance coverage and Medical Necessity policies.
- Customer service experience required.
- Knowledge of medical records software preferred.
- Completion of Hepatitis B Vaccine and Flu Vaccine Form will be required. Candidate may decline vaccination through declination form or may provide record of vaccination from previous employer.
- Completion of TB test will be required.
Physical Requirements:
- Work consistently requires walking, standing, sitting, lifting, reaching, stooping, bending, pushing, and pulling.
- Must be able to lift and support weight of 35 pounds
- Ability to concentrate on details.
- Use of computer for long periods of time.
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