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Referral Authorization Specialist

3 months ago

Sierra Vista, United States Canyon Vista Medical Center Full time
Job Description

Who We Are:

People are our passion and purpose. Come work where you are appreciated for who you are not just what you can do. Canyon Vista Medical Center is a 106 bed Joint Commission Accredited offering a number of specialty services. We are proud to serve our community with a Level III Trauma unit, Center of Excellence for Total Joint Replacement, Level I Nursery, American College of Radiology Accredited Facility, as well as many other state of the art services to ensure our patients are cared for. 

Where We Are:

Sierra Vista, Arizona is a flourishing city located 75 miles southeast of Tucson. Thanks to our year-round temperate climate, affordable housing, low cost of living, access to healthcare and education facilities, not to mention the breathtaking natural beauty of majestic mountain ranges and the San Pedro River and outdoor activities, Cochise County residents enjoy an excellent quality of life.

Why Choose Us:

  • Health (Medical, Dental, Vision) and 401K Benefits for full-time employees
  • Competitive Paid Time Off / Extended Illness Bank package for full-time employees
  • Employee Assistance Program – mental, physical, and financial wellness assistance
  • Tuition Reimbursement/Assistance for qualified applicants
  • And much more…

Position Summary:

The Referral/Authorization Specialist is responsible for servicing the needs of members, providers, and the Health Plans representatives. Obtains referral authorization from insurance carriers and relays such authorizations (or denials) to the patient and the provider. Carry out provider orders, such as standing orders and referrals. Verifies procedure codes are accurate on orders before sending. Resolves all pre-authorization, registration, or other referral-related issues prior to a patient's appointment. Upload/prepare for upload patient portal documents, including test results, visit summaries, etc.   Assist with phones as necessary.  Verifies member’s eligibility and benefits with subsequent notification to designated staff of eligibility issues. Notifies required parties within the appropriate timeframe for routine and urgent requests for services. May process/coordinate medical records requests. Complete orders for additional services based on notes from provider, finishing these tasks within the Electronic Medical Records (EMR) Athena Net.  Understand those insurance plans which require prior authorizations for services and relay information to providers/patients as necessary.  Ensure length of referral/number of visits is properly documented within Athena Net.  All other duties as assigned.

Minimum Qualifications:

  • High School Diploma or G.E.D preferred.
  • 1 to 2 years of experience preferred.

 

EEOC Statement:

Canyon Vista Medical Center is committed to providing Equal Employment Opportunities for all applicants and employees and complies with all applicable laws prohibiting discrimination against any employee or applicant for employment because of color, race, sex, age, religion, national origin, disability, genetic information, gender identity, sexual orientation, veterans' status or any other basis protected by applicable federal, state or local law.