Referrals and Authorization Specialist

Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond.  As a joined force of "people caring for people," Martin's Point employees are on a mission to transform our health care system while creating a healthier community.  Martin's Point employees enjoy an organizational culture of trust and respect, where our values - taking care of ourselves and others, continuous learning, helping each other, and having fun - are brought to life every day.  Join us and find out for yourself why Martin's Point has been certified as a "Great Place to Work" since 2015.
 

Position Summary
 

The Referral and Authorization Specialist plays a key role in ensuring patients at Martin’s Point Health Care receive timely and coordinated care. As a part of the Centralized Services team, this position works collaboratively with the health care centers, and health plans to manage the end-to-end referral and authorization process. The specialist acts as a liaison between internal providers, external specialists, pharmacies, and facilities to ensure that all referrals, pre-certifications, and prior authorizations are accurately processed in support of quality care delivery.

Job Description

PRIMARY DUTIES AND RESPONSIBILITIES

Employees are expected to work consistently to demonstrate the mission, vision, and core values of the organization. 

• Responsible for the processing and management of patient referrals, prior authorizations, and ancillary orders to/from specialists, insurance carriers, and facilities
• Coordinates and communicate with internal care teams to ensure timely handling of referral requests.
• Obtains required prior authorizations and pre-certifications from health plans in compliance with payer guidelines.
• Complies with all service standards, organizational policy and standard operating procedures for the processing and management of all patient referrals and prior authorizations.
• Ensures accurate documentation and tracking of all referral and authorization activities in EHR.
• Monitors referral or authorization status and follow up with providers or health plans as needed to avoid delays in care.
• Serves as a resource for patients and care teams regarding referral and authorization processes.
• Maintains confidentiality and comply with HIPAA regulations and organizational policies.
• Communicates updates from specialty partners in the community with staff and providers.

POSITION QUALIFICATIONS

There are additional competencies linked to individual contributor, provider, and leadership roles. Please consult with your leader to discuss additional competencies that are relevant to your position.

Education

• HS Diploma or equivalent

Experience

• 3+ years’ experience working in a medical environment with patient registration, billing, insurance processing or appointment scheduling
• Referral or authorization experience preferred

Knowledge

• Medical terminology
• Strong organizational, communication, and customer service skills.
• Ability to work collaboratively in a fast-paced, team-oriented environment.
• Knowledge of payer authorization and referral requirements
• Athena experience

Skills

• Basic computer skills: Word, Excel, etc.
• Positive interpersonal skills
• Collaborative
• Strong attention to detail

Abilities

• Ability to handle difficult conversations with patients and internal customers
• Problem solving
• Customer focused approach

This position is not eligible for immigration sponsorship.

We are an equal opportunity/affirmative action employer.

Martin's Point complies with federal and state disability laws and makes reasonable accommodations for applicants and employees with disabilities. If a reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact [email protected]

Do you have a question about careers at Martin’s Point Health Care? Contact us at: [email protected]