PRIMARY FUNCTION: Obtain authorization from insurance companies to assist patients in the referral process
SUPERVISION RECEIVED: Reports directly to Referral Manager
SUPERVISORY RESPONSIBILITIES: None
TYPICAL WORKING CONDITIONS: Work may require sitting for long periods of time, manual dexterity sufficient to operate a keyboard, type at 40 wpm, operate a calculator, telephone, copier, and such other office equipment as necessary. It is necessary to view and type on computer screens for long periods and to work in a high-volume, fast-paced environment. Ability to work remotely is required.
ESSENTIAL FUNCTIONS OF THE JOB: (This list may not include all of the duties that may be assigned.)
1. Obtain authorizations for all referral requests received as assigned
2. Review and understand documentation required by insurance companies to obtain authorization, including clinical notes, lab results, consult notes
3. Utilize insurance web portals to obtain authorizations as required
4. Accurately documents referral details, including status, authorization dates, authorization number, specialist/facility and other relevant information per policy
5. Effectively communicates updates in referral status with patients, clinicians and office site staff
6. Interacts professionally with specialists/facilities and insurance plan representatives
7. Remains current with company, health plan and specialist requirements
8. Prioritizes use of preferred specialist/facility within the EHR
9. Meets productivity standards as determined by management team
10. Manage workloads within notification and request bins in EHR to meet established timeframe expectations
11. Works collaboratively with department team members to ensure coverage
12. Manages high priority notifications and requests appropriately
13. Reviews and updates requests pending authorization daily
14. Communicates and collaborates effectively with Referral Manager and team members
Education Requirements: High School diploma or equivalent.
Knowledge, Skills & Abilities: Bilingual, fluent in English and Spanish. Knowledge of grammar, spelling and punctuation to type correspondence. Knowledge of insurance industry preferred. Skills in operating a computer, fax and photocopy machine. Ability to read understand and follow oral and written instruction. Ability to sort and file materials correctly by alphabetic or numeric systems. Ability to speak clearly and concisely. Ability to establish and maintain effective working relationships with patients, employees and the public. Typing ability of 40 w.p.m., word processing and computer experience.