- Ensure patients have been cleared for specialty services and office visits.
- Resolve authorization concerns prior to any patient's appointment.
- Confirm insurance coverage or lack thereof for patient.
- Obtain authorizations if needed from insurance coverage.
- 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.
- Perform routine administrative and clerical tasks to keep the offices of physicians and other health practitioners running smoothly.
- Perform administrative duties, including answering telephones, and greeting patients.
- Maintain service standards in accordance with the departmental/organizational policies.
- Perform related duties as assigned within scope of practice.
- Responsible for assisting with more complex patient issues and concerns.
- Assist supervisor/manager with monitoring inbound phone calls, call queue wait times and other assigned functions.
- Assists with training support of new hires.
- 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.
- Must demonstrate effective communication skills both verbally and written.
- Functional proficiency in computer software skills (e.g. Microsoft Word, Excel and Outlook, E-mail, etc.)
- Patient financial and practice management system experience in Epic and or other of electronic billing systems is preferred.
- Knowledge of medical terminology is preferred.
- Previous experience in an academic healthcare setting is preferred.
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Authorization & Referrals Specialist III #Full Time - Fort Lee, United States - 61st Street Service Corporation
Description
Job Summary:The Authorization & Referrals 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.
Job Responsibilities:
Note: Our salary offers will fall within these ranges based on a variety of factors, including but not limited to experience, skill set, training and education.
61st Street Service Corporation
At 61st Street Service Corporation we are committed to providing our client with excellent customer service while maintaining a productive environment for all employees. The Service Corporation offers a competitive comprehensive Benefit package to eligible employees; including Healthcare and various other benefits including Paid Time off to promote a healthy lifestyle.
We are an equal employment opportunity employer and we adhere to all requirements of all applicable federal, state, and local civil rights laws.
