Practice Prior Authorization and Referral Specialist

4 weeks ago

Bethlehem, United States St. Luke's Hospital Full time


St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care.

The Practice Prior Authorization and Referral Specialist is responsible for the coordination of prior-authorizations and referral process for patients being referred for specialty care, medications, and diagnostic procedures. Performs insurance verification, obtaining pre-authorizations, scheduling, and referrals. The specialist will secure the necessary prior authorization, then notify the patient aiding in the coordination of patient care.

JOB DUTIES AND RESPONSIBILITIES:

  • Receive request for patient requiring specialty care through the electronic health record (EHR), direct order by provider communication, phone, and/or fax.

  • Ensure patient demographic as well as insurance information are most accurate.

  • Reviews patient insurance information and eligibility / verification to obtain prior authorization for specialty care and/or services.

  • Obtain prior authorization from insurance companies prior to services being ordered and/or rendered.

  • Documents in EHR prior authorization approval to ensure proper reimbursement.

  • Works in collaboration with other supporting services / entities, central scheduling, and pre-encounters department.

  • Responds to written as well as telephone inquires from patients, insurances, pharmacies, other outpatient/inpatient departments, and facilities regarding planned specialty care and/or services.

  • Review and follow up on authorization and/or claim denials.

  • Notify ordering provider of a prior authorization denials and if peer to peer need to be scheduled.

  • Other duties as assigned.

PHYSICAL AND SENSORY REQUIREMENTS:

Sitting for up to 8 hours per day, 3 hours at a time. Consistent use of hands and fingers for typing, telephone, data entry, etc. Occasional twisting and turning. Uses upper extremities to life and carry up to 15 pounds. Stoops, bends, and reaches above shoulder level to retrieve needed materials.  Hearing as it relates to normal conversation. Seeing as it relates to general vision. 

EDUCATION:

High school diploma or equivalent required. Prior authorization experience preferred.

TRAINING AND EXPERIENCE:

One to two years of experience in medical billing, a medical office or insurances preferred.  Working knowledge of medical office procedures as well as detailed understanding of ICD 10 and CPT codes.  Knowledge of regulatory standards and compliance requirements.

Please complete your application using your full legal name and current home address.  Be sure to include employment history for the past seven (7) years, including your present employer.  Additionally, you are encouraged to upload a current resume, including all work history, education, and/or certifications and licenses, if applicable.  It is highly recommended that you create a profile at the conclusion of submitting your first application.  Thank you for your interest in St. Luke's

St. Luke's University Health Network is an Equal Opportunity Employer.

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