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Referral and Authorization Spec
3 months ago
Additional Position Details: FTE: 1.000000 | Full Time | 1st Shift - Days Position Summary The Referral and Authorization Specialist is responsible for processing all referrals from assigned area of specialty. This includes securing pre-authorizations when necessary to facilitate timely appointments and support continuity of care within the health system. As a Referral and Authorization Specialist for Asante, you will have the opportunity to: Receive and transcribe all referrals in Asante's referral tracking system, assist with coordinating the scheduling of care based on clinical protocols, and send confirmation for scheduled services to the patient. Ensure patient demographic and insurance information accompanying the referral is accurate and complete and follow up with referring clinics and/or patients as needed to fill in missing or incorrect information. Obtain pre-authorizations and pre-certifications from third-party payers in accordance with payer requirements and document the authorization number and period of validity in referral. Gather additional medical records from other providers as needed to support medical necessity when obtaining a preauthorization and follow up with payers on pre-authorization requests as needed. Identify patients who will need to receive Medicare Advance Beneficiary Notices of Noncoverage, along with Waivers for Oregon Health Plan and Commercial insurance patients. Accurately enter all referral information into appropriate systems daily in order to schedule the initial evaluation and follow up appointments as needed. Ensure Therapists have all clinical information necessary for referral appointments & authorization forms and sending any additional documents upon request. Alert the therapist involved in the patient's care when there are issues with referrals or complications with insurance coverage. Inform the patient whether the authorization for the referral has been approved or denied, and discusses what other possible form of payment may be applicable. Qualifications Associate Degree in business or healthcare related field, preferred Minimum of 3 years of healthcare related insurance, scheduling, front desk, or comparable experience is required CHAA: Certified Healthcare Access Associate is preferred What We Offer Competitive starting wage Comprehensive Total Rewards package including medical, dental, vision, and wellness; retirement plan with up to a 6% employer contribution; and a generous paid time off policy that increases with years of service Tuition Reimbursement after 1 year of service Why Asante Asante is more than a great hospital system in an amazing location. We are a community of passionate providers and service-focused caregivers who collaborate to deliver amazing patient outcomes; a place where titles don't matter as much as your creativity, drive, and passion. Our culture, values and people create an environment of sustained medical excellence. For more on our story and award-winning health care, click HERE. More About Asante and Southern Oregon Asante is a local, community owned and governed, not-for-profit organization that provides comprehensive health care services to more than 550,000 people in a nine-county area of Southern Oregon and Northern California. It includes Asante Ashland Community Hospital in Ashland, Asante Rogue Regional Medical Center in Medford, Asante Three Rivers Medical Center in Grants Pass, Asante Physician Partners throughout the Rogue Valley, and additional health care partnerships. Virtually all medical specialties and services are represented within an organization dedicated to providing exceptional care. With over 5,000 employees, Asante's entities offer outstanding opportunities for career advancement and professional growth. At Asante your work positively impacts your family, friends, neighbors and the community. Experience the difference in how you work, how you live and how you connect. At Asante we are defined by our values - traits that guide us as we serve patients and the community: Excellence - Respect - Honesty - Service - Teamwork Asante is an equal opportunity employer. We are committed to employ and advance in employment women, minorities, qualified individuals with disabilities and protected veterans.
