Authorization and Referral Specialist

Essential Duties And Responsibilities

• Provides friendly, courteous, and professional service at all times to all clients and patients.
• Answers in-coming telephone calls within three (3) rings and accurately directs and/or assists the caller.
• Forwards calls accurately to the correct person or extension and ensures that someone is answering on the extension before passing the caller.
• Calls patients to schedule advanced and same day appointments and accurately enters new or follow-up information into the electronic medical patient information system.
• Maintains and updates any patient or telephone logs that may be requested.
• Explains services and operating hours; knowledgeable about services offered.
• Completes and verifies patient eligibility and authorizations.
• Screens OB patients for presumptive eligibility for Pregnant Women (PEPW) and simplified Medicaid application.
• Verifies and/or updates demographics and insurance information in the appropriate electronic patient health information systems.
• Schedules patient appointments for the referred service with the indicated specialist’s office, providing them with authorization information, including authorization number.
• Contacts the patient informing them of the appointment information including date, time, location, and any other instructions required for the referred visit.
• Maintains referral/authorization information for tracking.
• Documents if an authorization is denied from the PCP, or the insurance company including the reason and date of services.
• Supports the goals and mission of MCR Health Services.
• Adheres to the safety policies of MCR Health Services.
• Performs other duties as assigned.

Skills

• Outstanding communication and customer service skills.
• Active Listening.
• Excellent written and oral expression.
• Problem Solving.
• Ability to multi-task.
• Empathy.
• Able to maintain confidences.
• Ethical Requirements.

Mental/Physical Demands

• Regularly required to drive, sit, use hands or fingers, handle or feel objects, tools, controls and talk or hear.
• Frequently required to walk, stand and reach with hands and arms.
• Occasionally required to climb or balance and stoop, kneel, crouch, or crawl.
• Occasionally lift and/or move up to 25 lbs.