Outpatient Administrative Specialist

4 days ago


Syracuse, New York, United States Upstate University Hospital Full time
Job Summary:

As an Outpatient Administrative Specialist in our Psychiatry department, you will play a vital role in ensuring the smooth operation of our outpatient services. Your primary responsibility will be to obtain insurance referrals and authorizations for outpatient office visits, diagnostic tests, and lab work. You will work closely with patients, families, providers, and insurance carriers to ensure all encounters are appropriate for maximum reimbursement, minimal denials, and adherence to carrier rules.

You will be responsible for completing check-in and scheduling for clinicians in Epic, communicating authorization, benefits, and limitations to providers and patients, and obtaining ABN or Waiver of Liability signatures. Additionally, you will work with providers to clarify patient documentation and coding requirements, obtain and provide letters of medical necessity as needed, and coordinate new patient referrals for services.

You will also be responsible for working with various computer programs, responding to concerns identified by statistical reports, monitoring billing, compliance, and coding information for changes pertinent to the practice, and serving as a resource for providers, house staff, and support staff for information relative to the referral and authorization processes.

Key Responsibilities:

  • Obtain insurance referrals and authorizations for outpatient office visits, diagnostic tests, and lab work
  • Work closely with patients, families, providers, and insurance carriers to ensure all encounters are appropriate for maximum reimbursement, minimal denials, and adherence to carrier rules
  • Complete check-in and scheduling for clinicians in Epic
  • Communicate authorization, benefits, and limitations to providers and patients
  • Obtain ABN or Waiver of Liability signatures
  • Work with providers to clarify patient documentation and coding requirements
  • Obtain and provide letters of medical necessity as needed
  • Coordinate new patient referrals for services
  • Work with various computer programs
  • Respond to concerns identified by statistical reports
  • Monitor billing, compliance, and coding information for changes pertinent to the practice
  • Serve as a resource for providers, house staff, and support staff for information relative to the referral and authorization processes

Requirements:

  • Associate's degree and two (2) years relevant patient financial/insurance services experience in a healthcare-related setting or equivalent combination of education and experience required
  • Working knowledge of medical terminology, familiarity with medical coding, and excellent written/oral communication skills required
  • Ability to maintain good public relations with patients, visitors, co-workers, and other individuals

Preferred Qualifications:

  • Previous ambulatory experience in an Outpatient Psychiatry setting preferred
  • Knowledge of Office of Mental Health regulations preferred
  • Prior working experience in ambulatory patient care administrative functions, including obtaining referrals and insurance authorizations, managing EPIC referral work queues, communicating with outside agencies, such as insurance carriers, billing companies, and/or other support agencies preferred


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