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Authorization & Referrals Specialist

4 months ago

Las Vegas, United States Cure 4 Full time
We don't train our people to be nice... We simply hire nice people

We are looking for the brightest and the best to join our team

Are you looking for a career in a high-paced, complex, and collaborative clinical environment?

Two major benefits offered by Cure 4 The Kids Foundation
  • One of the most competitive compensation and comprehensive benefit packages in the field of healthcare
  • A state-of-the-art clinical and administrative environment located at 215 and Town Center, Summerlin on the Roseman University Campus
Cure 4 The Kids Foundation was voted #10 on the list of the Best Non-Profits to Work For in the U.S.

What it takes to be part of our team
Are you an exceptional Authorization & Referral Specialist who can interact comfortably with direct and candid physicians as well as easier going personality types? Can you multi-task with a sense of purpose and urgency when needed? Do you absolutely thrive on being part of an accountable team serving the needs of children and their families? Do you bring the highest standards of integrity and professionalism to your team? Do you thrive in an environment where you are valued and appreciated for who you are, how hard you work and for that something special you bring to the teams you choose to work with? Are you looking for an organization that offers competitive compensation and one of the broadest and most comprehensive benefit packages available in the field of healthcare?

This is a role that requires a multi-disciplinary team approach to solving problems and patient challenges. "That's not my job" or "someone else can do it" is not in our team vocabulary because we are here to be of support to each other. The primary goal is to bring the best patient care and experience for our area's children.

SUMMARY: The Authorizations and Referrals Specialist for Imaging Procedures and Referrals schedules appointments, obtains authorizations for imaging procedures, and manages referrals for various medical services. Specialists in this role are responsible for administrative tasks related to obtaining authorizations and ensuring appointments are scheduled, as well as overseeing the completion of services. This is a non-exempt, full-time position.

ESSENTIAL DUTIES AND RESPONSIBILITIES:
  • Utilizes clinical data/knowledge to assist patients in gaining appropriate physician, hospital, radiology, medical group, and community referrals.
  • Utilizes computer software to process referrals and maintain up-to-date referral databases.
  • Obtains prior authorizations for imaging studies and various procedures ordered by practice providers, utilizing payer authorization tools such as forms, websites, telephone, or fax lines.
  • Maintains updated patient files with the most current coverage information available.
  • Monitors all incoming communications directed to the department.
  • Functions as a point of contact for assigned providers to answer and route questions about patient care.
  • Processes patient referrals and prior authorization requests in accordance with departmental guidelines. Other duties as assigned.
  • Other duties as assigned.
REQUIRED EDUCATION AND EXPERIENCE:
  • High school diploma or GED.
  • Two (2) years of experience in tertiary patient care setting involving interaction with a variety of medical services, contact with patients and families, and interaction with physicians.
PREFERRED EDUCATION AND EXPERIENCE:
  • Bachelor’s degree in health-related field.
KNOWLEDGE, SKILLS, AND ABILITIES:
  • Ability to coordinate and oversee the simultaneous execution of multiple tasks efficiently.
  • Strong understanding of CPT, ICD-10 coding, and medical terminology.
  • Knowledge of managed care and other insurance plan benefits and coverage; including experience with the insurance authorization process.
  • Demonstrates exceptional adaptability and a proactive approach to enhancing processes through continuous improvement and openness to procedural changes.
  • Ability to deliver exceptional customer service against regular background noise and conversations, ensuring clear communication over the telephone both in speaking and listening.
PHYSICAL REQUIREMENTS:
  • Prolonged periods sitting at a desk and working on a computer.
  • Handles several face-to-face and telephone contacts daily.
  • Occasionally required to stand, walk, and lift/push/carry items up to 15 pounds.

LANGUAGE SKILLS: Bilingual (English/Spanish) preferred, but not required.

Cure 4 The Kids Foundation participates in E-Verify.

Shift Schedule: 8:30am - 5:00pm