Referral/Prior Authorization Specialist - Monadnock Gastroenterology Associates - Per Diem

About the role

The referral & prior authorization specialist is responsible for ensuring the timeliness and accurate use of referrals by; monitoring appropriateness, medical necessity, and providing necessary information to obtain authorization. Performs telephonic support for online authorization of routine services, provides direct support to Primary Care practices and specialty care providers regarding utilization, authorization, and referral activities. Becomes proficient in the use of ICD-9/ICD-10 and CPT codes, contacts providers with authorization, denial, and appeals process information, assists in educating and acting as a resource to primary care practices and specialty care providers in regards to prior authorization needs, verifies eligibility of members and participating status of providers, determines member benefit coverage, performs other duties as required.

Responsibilities

• Makes insurance authorization from in-network and out-of-network insurance carriers for New Patient and Follow-Up visits with our medical providers.
• Processes physician referral orders (EMG, CT, MRI, etc.) using eCW (EMR system).
• This includes obtaining any insurance authorization needed.
• Calls incoming referrals and schedules office visits based on the referral.
• Demonstrate and apply knowledge of medical terminology, high proficiency of general medical office procedures including HIPAA regulations.

Requirements

This is a per diem position.

Qualifications

• High school diploma or equivalent.
• Experience in healthcare or related field preferred.
• Knowledge of medical terminology and HIPAA regulations.
• Proficiency in using ICD-9/ICD-10 and CPT codes.
• Excellent communication and interpersonal skills.

Skills

• Medical Terminology
• High Proficiency of General Medical Office Procedures
• HIPAA Regulations
• ICD-9/ICD-10 and CPT Codes

Benefits

Amazing people deserve amazing benefits. We strive to employ and retain the most highly qualified individuals by providing equitable wages and benefits, promoting from within, and supporting the continuing education efforts of our staff. You will be valued and rewarded for the work you do here with excellent pay and outstanding benefits. At MCH, you’ll find great opportunities for career advancement as well as personal and professional growth.

Pay

Details of pay are not specified.

Schedule

This is a per diem position.