Authorization & Referral Specialist

Essential Functions

• Excellent interpersonal skills required to communicate with Care Team and funding sources.
• Possess excellent time management and organizational skills.
• Demonstrate critical thinking, creativity, problem solving and decision-making skills.
• Work with federal, state, local and intermediary specific billing requirements to ensure appropriate authorizations are complete.
• Notify appropriate person of missing or incomplete billing requirements and follow up in a timely manner.
• Assist in educating and acting as a resource to the Care Team regarding authorizations.
• Assure all pre-authorizations have been approved with the proper procedure code prior to service being rendered.
• Knowledgeable of current changes in coding and reimbursement requirements for all billing payors.
• Contact providers with authorization, denial and appeals process information.
• Research and work with patient success and billing departments in researching and resolving rejected, incorrectly paid or denied claims as requested.
• Greet patients and visitors in a courteous and friendly manner.
• Ensure that all necessary documentation is completed prior to obtaining authorization.
• Maintain regular and predictable attendance.
• Perform other essential duties as assigned.

Requirements

• Educational requirement: High school diploma or equivalent.
• Experience: Minimum two years’ general office work experience is preferred.
• Skills: Computer and EMR experience, medical terminology-preferred, organizational skills, advanced typing skills, effective communication, ability to act as a liaison, familiarity with medical office practices and medical insurance, familiarity with ICD-10, CPT, HCPCS codes, self-motivation, adherence to policies, procedures and practices prescribed by the hospital/clinic.

Physical/Mental Requirements

• Must be able to sit and stand, intermittent 8 to 10 hours a day.
• Must be able to use standard office equipment, including the telephone and computer keyboard.
• Continuously works under pressure of near 100% accuracy while meeting inflexible deadlines.
• Continuously utilizes manual/bi-manual dexterity, near vision, speech, and hearing.
• Frequently stands, walks, sits and utilizes eye/hand coordination and color definition.
• Occasionally reaches above shoulder, regularly required to lift and/or carry up to 40 lbs.
• Occasionally walks on uneven surfaces.