Responsible for timely processing, documenting, scheduling and follow up of referrals and request for treatment authorizations as requested by the primary physician.
Essential Functions of the Job:
- Receives and processes authorizations on timely manner with the at most attention to quality, accuracy and completeness of work.
- Plans in advance to ensure task are complete and seeks to add value to every work assignment.
- Schedules requests for referrals and treatment authorizations.
- Demonstrates skills and knowledge to obtain authorizations from various insurance carriers via phone, in writing or electronic media, adjusting effectively to organizational changes maintaining high standards.
- Follows-up on missing documentation to obtain authorization when appropriate; schedules appointment for specialty care, or other ancillary services as requested by the primary care physician.
- Coordinates care within the guidelines of multiple health plans, contracts or insurance types. Uses various modules of the computer system to obtain information, schedule appointments, query information and obtain authorizations.
- Responds to inquiries as to current status of authorization by assessing the request and evaluating the circumstances to provide regular, consistent, timely, and meaningful information to our patients.
Additional Duties and Responsibilities:
- Maintains established departmental policies and procedures.
- Adheres to standards of ethical conduct and professional compliance.
- Enhances professional growth and development through participation in educational programs, current literature, in-service meetings and workshops; modeling a high performance work ethic and constant self-improvement.
- Attends meetings as required and participates in committees as directed; works cooperatively with others to meet shared objectives. Fosters an environment that encourages group participation and inclusiveness. Takes initiative to improve processes and identify root causes: maintaining a focus on solutions.
- Performs other related duties as assigned or requested by Supervisor or Manager.
- Minimum of 1 year experience in healthcare setting to include front with back office or referral authorization knowledge of programs and health plans eligibility and guidelines, coding and data processing or Medical Assistant Certificate.
- Preferred: 2 years in healthcare setting