Practice Prior Authorization and Referral Specialist, Sleep Medicine Office - Fountain Hill - ST. LUKE'S UNIVERSITY HEALTH NETWORK

    ST. LUKE'S UNIVERSITY HEALTH NETWORK
    ST. LUKE'S UNIVERSITY HEALTH NETWORK Fountain Hill

    3 days ago

    St. Luke's University Health Network background
    Full time
    Description

    Job Summary

    St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other healthcare providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for healthcare.

    Job Description

    The Practice Prior Authorization and Referral Specialist is responsible for coordinating prior-authorizations and referral process for patients being referred for specialty care, medications, and diagnostic procedures. Performs insurance verification, obtaining pre-authorizations, scheduling, and referrals. The specialist will secure the necessary prior authorization, then notify the patient aiding in the coordination of patient care.

    Key Responsibilities:

    • Receive requests for patients requiring specialty care through the electronic health record (EHR), direct order by provider communication, phone, and/or fax.
    • Ensure patient demographic as well as insurance information are accurate.
    • Reviews patient insurance information and eligibility/verification to obtain prior authorization for specialty care and/or services.
    • Obtain prior authorization from insurance companies prior to services being ordered and/or rendered.
    • Documents in EHR prior authorization approval to ensure proper reimbursement.
    • Works in collaboration with other supporting services/entities, central scheduling, and pre-encounters department.
    • Responds to written as well as telephone inquiries from patients, insurances, pharmacies, other outpatient/inpatient departments, and facilities regarding planned specialty care and/or services.
    • Review and follow up on authorization and/or claim denials.
    • Notify ordering provider of a prior authorization denial and if peer-to-peer need to be scheduled.

    Physical and Sensory Requirements:

    Sitting for up to 8 hours per day, 3 hours at a time. Consistent use of hands and fingers for typing, telephone, data entry, etc. Occasional twisting and turning. Uses upper extremities to lift and carry up to 15 pounds. Stoops, bends, and reaches above shoulder level to retrieve needed materials. Hearing as it relates to normal conversation. Seeing as it relates to general vision.

    Education:

    High school diploma or equivalent required. Prior authorization experience preferred.

    Training and Experience:

    One to two years of experience in medical billing, a medical office or insurances preferred. Working knowledge of medical office procedures as well as detailed understanding of ICD 10 and CPT codes. Knowledge of regulatory standards and compliance requirements.

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