Referral Authorization Specialist

2 weeks ago


Fall River, United States Complete Staffing Solutions Full time
Job DescriptionJob Description

32 HPW Referral Authorization Specialist

Type: Temp-Hire

Hours: 32 HPW

  • Monday, Tuesday, Thursday 9:00am - 4:30pm
  • Wednesday, Friday 10:00am - 2:00pm

Responsibilities:

  • Perform wide variety of duties to secure optimal; revenue for all services
  • Determine patient liability prior to service by creating estimate based on individual payer, notifies patient of their potential liability
  • Initiate contact with patients, clinicians, and third party payers to obtain pre-certification and authorization for evaluations and diagnostic tests
  • Use critical thinking skills to ensure CPT codes are documented and authorized for the appropriate service
  • Navigate multiple payer portals to determine requirements for authorization and submit electronic requests
  • Follow up with payer denials by researching clinical data to support appeal
  • Verify coverage and initiate authorizations for new evaluations and treatments

Requirements:

  • MUST have Prior Authorization / insurance experience in healthcare setting.
  • An understanding of billing and codes strongly preferred
  • Equal to completion of four years of high school plus additional specialized courses or training, secretarial school, diploma, or medical office certification.
  • Duties require knowledge of medical terminology.
  • Proficient keyboarding skills are essential.
  • Must possess strong reasoning and critical thinking skills.
  • Proficient in use of software applications such as e-mail, Word, Excel, EHR.
  • Exceptional customer service skills are required.
  • Associates degree preferred.


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