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Authorization & Referrals Specialist I #Full Time
3 months ago
The Authorization-Referrals Specialist I is responsible for verifying insurance policy benefit information, and securing payer required referrals and authorizations. This position is responsible for obtaining accurate and timely pre-authorizations for professional services prior to the patient's visit, scheduled admission, or immediately following hospital admission. Prior authorizations may include, but are not limited to surgical procedures, outpatient treatments, medications and diagnostic testing (i.e. ultrasounds, labs, radiology, IV therapy, referrals)
Job Responsibilities:
- Verify insurance coverage via system tools and payer portals and update changes in the billing system.
- Confirm provider's participation status with patient's insurance plan/network.
- Determine payer referral and authorization requirements for professional services.
- Secure payer required referral for planned services.
- Document referral in practice management system.
- Initiate authorization and submits clinical documentation.
- Obtain final approval on pre-certifications.
- Manage faxes, emails, and phone calls.
- Communicate with surgical coordinators regarding authorizations status or denials.
- Submit appeals in the event of denial of prior authorizations or denial of payment following procedures.
- Set up peer to peer calls with clinical providers and insurance companies.
- Calculate and document patient out of pocket estimates and provide to patient.
- Performs other job duties as assigned.
- High school graduate or GED certificate is required.
- A minimum of 6 months experience in a physician's billing or third payer environment.
- Candidate must demonstrate the ability to understand and navigate managed care eligibility, insurance billing requirements, and obtaining pre-authorizations.
- 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, document, and manage time effectively.
- Functional proficiency in computer software skills (e.g. Microsoft Word, Excel and Outlook, E-mail, etc.)
- Functional proficiency and comprehension of medical terminology.
- Ability to work independently and collaborate in teams.
- The ideal candidate is a motivated individual with a positive attitude and exceptional work ethic.
- Experience in Epic and or other of electronic billing systems is preferred.
- Knowledge of medical terminology, diagnosis and procedure coding is preferred.
- Previous experience in an academic healthcare setting is preferred.
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.
