Outpatient Referral & Authorization Representative-8111

Key Responsibilities

• Consistently demonstrates a willingness to assist co-workers in a courteous manner to support department efficiency.
• Develops and maintains good human relations skills by practicing AIDET, KRMC’s values, and behavioral standards with employees, patients, medical staff, and visitors in accordance with performance of duties.
• Maintains positive attitude and functions as a team player.
• Protects patient information and hospital financial reimbursement by inputting authorization information.
• Verifies the insurance and ensures that all notification/authorizations are completed in a timely manner as well as ensuring patient services are a covered benefit.
• Inputs notes pertinent to financial information to assist billing department in payment of the claim.
• Contacts responsible party of outpatient referral by telephone to advise of insurance coverage rate when insurance does not cover 100%; professionally advises responsible party of payment requirements and follows hospital policy in establishing payment arrangements or advises other referral sources.
• Contact is made before referral is sent to referring provider/department.
• Mets productivity standards for working incoming referrals to schedule financially cleared outpatient visits in a timely manner. Referrals should be processed within three (3) business days. Authorization should be initiated within three (3) business days.
• Maintains statistical information regarding payers and communicates info routinely to Outpatient Scheduling Center Supervisor/Manager.
• Aids in the education of Outpatient Scheduling Reps.
• Completes all assigned duties, and other duties as assigned, accurately and in a timely manner.

Qualifications

• Education: High school graduate/GED or 2-5 years healthcare experience in lieu of education requirement.
• Experience: Six months or more of progressive work experience.
• Skills: Ability to communicate effectively with others. Manage multiple priorities and tasks. Maintain attention to detail. Knowledge of and ability to use computer hardware and software applications.
• Preferences: Experience: One-year hospital outpatient referrals and/or insurance verification experience preferred. Skills: Knowledge of medical terminology, coding rules and guidelines preferred.