Prior Authorization/Referral Specialist

3 weeks ago


Kalamazoo, United States Advanced Cardiac Healthcare, PLC Full time
Job DescriptionJob Description

Our busy Kalamazoo Cardiology office is searching for a full-time prior authorization and referral specialist. The applicant must possess excellent communication and problem solving skills. The candidate should also have the ability to work effectively when faced with high volumes and multiple interruptions.  Must have the ability to accurately interpret data definitions and communicate both verbally and in writing.  The ideal candidate is highly organized, professional and self-directed.  This position requires active communication with contacts in the hospital, as well as insurance and governmental agencies.   Salary commensurate with experience.


JOB REQUIREMENTS:
•    1+ year experience in a physician office setting, preferred
•    Experience with 3rd party payor claim processing.
•    Knowledge of medical terminology, standard medical abbreviations, and pharmacy terms sufficient to identify proper location of specific            health information. 
•    EMR experience 
•    Current certification through AMT or AAMA is a plus

GENERAL SUMMARY OF DUTIES:
•    Act as a referral coordinator and central resource/liaison for the assigned specialties across all sites of service, ordering providers and           insurers. 
•    Responsible for obtaining prior authorizations for procedures
•    Responsible for prioritizing incoming patient referrals correspondence and make appropriate patient appointments.
•    Assist in the Coordination of peer-to-peer reviews between the servicing provider and medical directors at the insurance company when         appropriate.
•    Obtain retro authorizations on billed and rejected claims and denied procedure codes for facility and professional services.  
•    Initiate appropriate follow-up actions in response to information obtained and document outcomes. 
•    Provides information to patients so they may fully utilize and benefit from the clinic services
•    Data entry and documentation as needed
•    Schedule procedures and tests
•    Organize and maintain medical records
•    Complete special projects as assigned
•    Attend appropriate meetings

This job is 40 hours per week, Monday through Friday. We offer a very generous benefit package with Life, Health, Dental, Rx, Vision, Disability, 401k and Flex Spending Accounts. 
 

Company DescriptionLarge, physician owned specialty practice.Company DescriptionLarge, physician owned specialty practice.
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