Referrals & Authorizations Specialist I

Job Description Summary

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Completes registration and obtains insurance authorization for new patients, diagnostic testing and for hospital admissions.
Ensures financial information and insurance has been verified.
Updates patient insurance information in billing systems as needed
Initiates the referral and authorization process for all services and visits.
Works closely with nursing and medical staff to facilitate optimal patient care.
Communicates with the scheduling department to verify each patient’s insurance requirements have been satisfied for upcoming appointments.
Coordinates with other departments as needed to facilitate patient’s visit.
Provides patient with referral information for other physicians and facilities.
Communicates effectively with all internal and external customers – PCP, Patient, clinical departments, etc. in order to obtain the required authorization needed for each service.

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How will you make an impact & Requirements

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• Collaborates with referring physician offices to ensure referrals are completed appropriately
• Ensures that referrals are addressed in a timely manner
• Reviews details and expectations about the referral with patients
• Communicates effectively about the EMR system
• Needs basic knowledge of insurance information (i.e. HMO vs. PPO), classes of insurance and is able to instruct and explain to the patient
• Makes outgoing calls to patients to inform them of the preferred in network provider that they are being referred to
• Verifies if patient would like assistance in coordinating the appointment
• Verifies with patient that all information is attached to request
• Coordinates scheduling of appointments when appropriate on behalf of patients with specialist offices
• Communicates effectively and professionally with specialist offices
• Assists in sending Athena fax request to specialist office
• Ensures complete and accurate registration, including patient demographic and current insurance information
• Assembles information concerning patient's clinical background and referral needs. Per referral guidelines, provide appropriate clinical information to specialist  
• Demonstrates the skills of effective communication, decision-making and organization to ensure efficient job performance and job success
• Daily work is accomplished with minimal direct supervision
• Work priorities are set in order to accomplish task/goals
• Confidential matters are handled appropriately
• Provides high-level customer service to both referring physicians as well as referred patients
• Confidentiality of patient data is maintained at all times
• Workspace is maintained in an organized and professional manner
• Courteous and professional demeanor is demonstrated at all times

Knowledge, Skills & Abilities:

• Excellent written and verbal communication skills with the ability to effectively communicate and establish collaborative relationships with physicians, patients, clinical and administrative staff and the public

• Excellent customer service skills

• Knowledge of clinic office procedures, medical practice and medical terminology
• Ability to recognize, evaluate and solve problems
• Strong organizational skills and attention to detail
• Proficient in the use of end-user computer applications regarding productivity (MS Word, Excel, Outlook), database and patient scheduling and other medical information systems
• Ability to operate various types of office equipment