Practice Authorization and Referral Coordinator, Sleep Medicine Office
1 month ago
St. Luke's University Health Network is seeking a skilled Practice Prior Authorization and Referral Specialist to join our team. This role is responsible for coordinating prior-authorizations and referral processes for patients requiring specialty care, medications, and diagnostic procedures.
Key Responsibilities- Verify patient demographic and insurance information to ensure accurate prior authorization requests.
- Review patient insurance information and eligibility to obtain prior authorization for specialty care and services.
- Obtain prior authorization from insurance companies before services are ordered or rendered.
- Document prior authorization approvals in the electronic health record to ensure proper reimbursement.
- Collaborate with other supporting services, central scheduling, and pre-encounters departments to ensure seamless patient care.
- Respond to patient and insurance inquiries regarding planned specialty care and services.
- Review and follow up on authorization and claim denials.
- Notify ordering providers of prior authorization denials and schedule peer-to-peer discussions as needed.
- High school diploma or equivalent required.
- Prior authorization experience preferred.
- One to two years of experience in medical billing, a medical office, or insurance preferred.
- Working knowledge of medical office procedures and detailed understanding of ICD-10 and CPT codes.
- Knowledge of regulatory standards and compliance requirements.
St. Luke's University Health Network is an equal opportunity employer. We offer a competitive salary and benefits package, as well as opportunities for professional growth and development.
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