Referral Authorization Specialist

About the role

Your Experience Matters Memorial Medical Center is part of Lifepoint Health, a diversified healthcare delivery network with facilities coast to coast. We are driven by a profound commitment to prioritize your well-being so you can provide exceptional care to others. As a Referral Authorization Specialist, joining our team, you're embracing a vital mission dedicated to making communities healthier®. Join us on this meaningful journey where your skills, compassion and dedication will make a remarkable difference in the lives of those we serve. Memorial Medical Center is a 199-bed acute medical/surgical teaching hospital located in Las Cruces, NM, and is part of Lifepoint Health, a diversified healthcare delivery network committed to making communities healthier® with acute care, rehabilitation, and behavioral health facilities from coast to coast.

Responsibilities

• Ensures patients receive the care they need in a timely manner by processing referrals completely, accurately, and promptly; verifying that patients receive the required care; and notifying providers when patients do not follow through with referrals.
• Completes pre-authorizations for diagnostic testing, therapy, surgical procedures, and specialty care appointments according to insurance requirements within three days of issuance.
• Notifies patients when referrals are approved and notifies providers when referrals are denied or when a second opinion or additional information is required.
• Documents all communication with patients, nurses, and providers in the clinic EMR.
• Updates referral records in the EMR following each communication with patients, insurance providers, nurses, or providers.
• Maintains up-to-date knowledge of health care plans and interprets and communicates plan policies and procedures to employees, physicians, and patients when changes occur.
• Identifies and attempts to resolve patient barriers to specialty care, including assisting with appointment scheduling and coordinating with specialist offices.
• Assists with tracking high-priority referrals to ensure patients in high-risk categories receive necessary follow-up care.
• Assists with patient assessments and treatments under the supervision of a physician or nurse.
• Performs administrative and clerical duties as assigned, including filing, reception, scheduling, data entry, and patient registration.
• Performs other duties as assigned.

Qualifications

High school diploma or equivalent is required. Two years of college preferred.

Skills

• Critical thinking skills
• Decisive judgment
• Ability to work with minimal supervision
• Ability to work in a stressful environment and take appropriate action

Benefits

• Multiple levels of medical, dental and vision coverage for full-time and part-time employees.
• Financial Protection & PTO: Life, accident, critical illness, hospital indemnity insurance, short- and long-term disability, paid family leave and paid time off.
• Financial & Career Growth: Higher education and certification tuition assistance, loan assistance and 401(k) retirement package and company match.
• Employee Well-being: Mental, physical, and financial wellness programs (free gym memberships, virtual care appointments, mental health services and discount programs).
• Professional Development: Ongoing learning and career advancement opportunities.

Schedule

Full-time