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Referral Authorization Clerk

4 months ago

Colorado Springs, United States Urology Associates Full time
Job DescriptionJob DescriptionPosition Summary:
Works with surgery scheduling, front office staff, radiology scheduling and billing to ensure that insurance referrals are in place and current with appropriate visits available. Contacts insurance carriers for pre-authorizations of procedures and medications and ensures that required approvals are obtained prior to patient visit. Responsible for accurate data entry of patient demographics and documentation of all pre-authorizations. Responsible for calculating estimated patient responsibility for procedures. Ensures that all details of the visit are communicated to the patient including estimated cost when appropriate so that upon arrival the appointment can go as scheduled.
Qualifications:
  • High school degree or GED required, college degree preferred
  • Computer skills required.
  • Insurance authorization experience preferred.
  • Medical scheduling preferred.
  • Strong organization skills.
  • Strong communications skills, both oral and written.
  • Some medical terminology knowledge

Contacts:
Interacts with all levels of the URA and Anova business organization, insurance carriers, patients and hospitals.
Job Responsibilities:
  • Have excellent understanding of all protocols regarding referrals and pre-authorizations as designated by the departments. Exceptional attention to detail.
  • Knowledge/understanding of all appointment types.
  • Pulls reports daily to ensure that patient referrals and authorizations are completed prior to patient arrival.
  • Maintain standard of 2 weeks ahead of appointment date for all pre-auths and referrals.
  • Maintain/recheck documentation and scan completed authorizations and pre-auths into EHR.
  • Enters authorization information, including estimated cost and authorization status, into notes in the patient management system and EHR.
  • Reply to all inter-office email requesting authorizations and referrals.
  • Communicates with office and nursing staff upon completion of urgent/stat referral/ preauths.
  • Contact patients in a timely and friendly manner when needed to obtain insurance information.
  • Request referrals from PCP’s for new and established patients.
  • Attach/Link required referrals to appointments.
  • Obtain Pre-authorization when required for: Testopel, PTNS, BCG, Botox, Rezum, Xgeva, Eligard, Gem/Doce, Lupron, Mitomycin, Xiaflex, CMG, TRUS, Bx, Visicoil, Aveed, Trelstar, Valstar, Firmagon, CTs and MRIs related to Anova, all Radiation Therapy treatments including IMRT, SBRT and SRS.
  • Contact patients with estimated cost prior to appointment and document in PM.
  • Run reports to ensure that all authorizations have been received.
  • Follow up on outstanding referrals.
  • Conduct business in a professional manner at all times, treating patients and coworkers with respect and dignity; avoid use of inappropriate language.
  • Other job duties as required.

Physical Requirements
  • Manual Dexterity
Constantly required to perform gross body coordination such as walking, stooping, and standing while performing tasks, carrying and lifting objects. Constantly required to perform simple motor skills and manipulative skills such as typing and writing.
  • Mobility
Constantly required to sit for long periods of time.
Required to walk and stand (including for long periods of time).
  • Visual Discrimination
Constantly required to read computer screen.
  • Hearing
Constantly required to hear normal sounds with some background noise when answering phones.
  • Mental Requirements:
Able to process great amounts of information, multi-task, apply problem solving skills and exercise good judgment. Able to concentrate on details with interruptions.