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Medical Authorization and Referral Specialist

5 months ago

Wildwood, United States Florida Retina Institute Full time

1.1 Begin accurately working on pulled patient appointment charts 3 days in advance, if possible, to complete the following task in a timely manner:
A. For patients who have only EMR charts: Print off last EMR note and place in folder.

B. For patients who are in the EMR system and also have a paper chart: Print off last EMR note and include in paper chart.

C. For patients who only have paper charts and are not yet in the EMR system: Include the paper chart and print out the Financial Demand Inquiry from the old MYSIS/Allscripts system.

1.2 Assure that the Verification List is obtained at least 3 days in advance from the Verification Specialist and assure that all visits and procedures have been verified prior to the patient visit.

1.3 Begin authorization process at least 3 days in advance prior to patient visit, when possible.

1.4 Accurately obtain visit and procedure authorizations through patient primary care physicians or patient insurance payers.

1.5 Assure that authorization numbers are documented, and that primary care physician fax sheets are scanned into the EMR, as well as documented in Practice Plus and on the encounter form.

1.6 For authorizations obtained through the patient’s insurance carrier, assure that the authorization numbers are documented and attached to the appointment in Practice Plus, as well as documented on the encounter form.

1.7 Assure that the number of visits or treatments authorized are clearly documented in Allscripts and on the encounter form. Indicate the number of approved visits or treatments that are left from the original authorization is also documented.

1.8 Assure that injection authorizations are obtained and up-to-date, as well as documented in Practice Plus and on the encounter form.

1.9 Assure that the file cases are packed and completed each day and ready to go to the practices.

1.10 Accurately processes authorizations for add on patients from all offices.

1.11 Highlights balances and assures that accurate co-pays and deductibles due are indicated on encounter forms.

1.12 Double checks to ensure all demographic information on the encounter is accurate (i.e. name spelling, referring doctor, etc.)

1.13 Utilizes patient chart on an as needed basis, accessing only information related to treatment, payment, and health operations.

1.14 Maintains and adheres to the company’s HIPAA, Compliance, and OSHA regulations.

1.15Other duties as assigned.

Excellent benefits package provided including Medical, Dental, Vision, LTD, STD, 401k matching, uniform allowance.

**This is not a remote position.**
'

**Benefits**:

- 401(k)
- 401(k) matching
- Dental insurance
- Employee assistance program
- Flexible spending account
- Health insurance
- Life insurance
- Paid time off
- Retirement plan
- Vision insurance

Weekly day range:

- Monday to Friday

Work Location: In person