Referral Authorization Specialist

Company : Tryon Medical Partners

Job Description - Referral Authorization Specialist

Referral Authorization Specialist

General Job Summary: The Referral Specialist will be responsible for managing referrals from the practice to other facilities or service providers and incoming action referrals from other service providers.

(This is a full-time position that will be based out of our SouthPark TPC office, Monday to Friday 8 am to 5 pm)

Primary Job Responsibilities:

Complete all referrals for the clinics and ensure they are processed effectively, making sure they are sent to the correct department.
Responsible for prioritizing Stat Referral Authorizations.
Obtains prior authorizations for medications needed.
Follow up on sent referrals.
Review benefits and educate patients on insurance coverage.
Keep the system up to date with any changes in information.
Manage referral status to ensure clinics have all updated and current information.
Completes referrals for patients and coordinates with referring and receiving practices and/or departments.
Obtains and maintain prior authorizations for diagnostic and ancillary testing.
Reviews schedules and confirms schedules are accurate and time is properly allocated.
Handle sensitive information in a confidential manner.
All other duties as assigned.

Clinic Support responsibilities include:

Assembles patients’ health information including patient symptoms and medical history, exam results, X-ray reports, lab tests, diagnoses, and treatment plans.
Ensures all related reports, labs and demographics are sent to the outside facility prior to their appointment.
Reviews to ensure all forms are completed, properly identified, and signed and that all necessary information in the EHR.
Communicates as needed with physicians and other health care professionals to clarify diagnoses or obtain additional information.
Obtains lab/X-ray reports, hospital notes, referral information, etc.
Verifies insurance coverage and patient demographics.
Updates charts to ensure that information is complete and filed appropriately.
Ensures timely delivery of outside mail and communication to the physician

Requirements:

Education, Experience and Certifications:

High School Diploma or GED required.
Minimum 2 years’ experience in a health coordination role.
Demonstrated understanding of industry guidelines and best practices.
Thorough understanding of insurance coverage and Medical Necessity policies.
Certified Prior Authorization Specialist preferred or prior experience as a Medical Assistant or Licensed Pharmacy Technician.
Customer service experience required.
Knowledge of medical records software preferred.
Completion of Hepatitis B Vaccine and Flu Vaccine Form will be required. Candidate may decline vaccination through declination form or may provide record of vaccination from previous employer.
Completion of TB test will be required.

Physical Requirements:

Work consistently requires walking, standing, sitting, lifting, reaching, stooping, bending, pushing, and pulling.
Must be able to lift and support weight of 35 pounds.
Ability to concentrate on details.
Use of computer for long periods of time.

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Referral Authorization Specialist

Job Description - Referral Authorization Specialist

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