Job Type:
RegularScheduled Hours:
40Job Summary:
Reports to the Revenue Cycle Manager, the Referral/Auth Mgmt. Specialist is accountable for a wide range of duties relating to the referral process as defined by the initial Scope of the Referral Mgmt-Auths Department. It is expected that the role of the Referral/Auth Mgmt. Specialist will evolve as the department expands and the central department absorbs additional office functions. The position is responsible for multiple cross-functional activities including: 1) Scheduling all specialty referrals (I.e. patient consultations, new patient visits and office visits), 2) Scheduling diagnostic tests, 3) Pre-certifications for diagnostic tests and procedures and 4) Pre-Authorizations for all specialist referrals. The Central Specialist will be expected to interact professionally with patients, SEP, independent physician offices, and insurance companies.Job Description:
Job Title: Referral Authorization Management Specialist
BENEFITS:
- Work from Home Opportunity (Equipment Provided)
- Paid Time Off
- Medical, Dental, and Vision
- 403b with Match
- Opportunity for Growth
DUTIES AND RESPONSIBILITIES:
- Understand and uphold SEPs Mission, Vision, and Values.
- Comply with all applicable laws and regulations.
- Schedules appointments for patients by phone when contacted by an office, by the patient directly, or by placing an outbound call directly to the patient. a. Uses manual/computerized system to match physician/clinician availability with patients preferences in terms of date and time. b. Communicates as needed with physicians/clinicians and other staff about any patient concerns/issues related to scheduling. c. Communicate with patient as needed.
- Monitors work queues in Epic relating to pre-certification/ pre-authorization and scheduling.
- Completes pre-certification/ pre-authorization for tests, procedures, and referrals (If Applicable).
- Communicates/ interacts with various insurance companies professionally and competently during the pre-certification/ pre-authorization process.
- Verifies patient demographic information.
- Verifies current insurance by recording insurance card and ensuring current updates in the practice management and electronic medical record systems.
- Reminds patients of any outstanding balances.
- Ensures completion of referral process, outpatient test scheduling, and pre-certification.
- Ensures accurate and timely distribution of patient requests.
- Works with central billing office as needed in a timely manner on all requests.
- Uses customer service principles and techniques to deal with patients calmly and pleasantly.
- Answers telephones within three rings and is helpful and friendly.
- Other duties and responsibilities as assigned are complete on a timely, thorough and accurate basis.
REQUIRED SKILLS AND KNOWLEDGE:
Ability to manage and prioritize multiple tasks, strong working knowledge of Referrals, Pre-certification/ Pre-authorization, Customer Service, Outlook and the ability to learn other computer skills. Must have good organizational skills and work professionally with doctors, hospital administration, management, SEP employees and the public.
OTHER REQUIRED SKILLS AND KNOWLEDGE:
- Knowledge of current practice management and electronic medical record systems- Epic preferred (training provided).
- Extensive knowledge of insurance plans accepted by SEP.
- Extensive knowledge of referral process for insurance plans accepted by SEP.
- Experience in a physician practice is preferred.
- Demonstrated ability to work successfully in a team-based decision-making culture.
- Demonstrated ability to work independently resulting in effective outcomes and on-time performance.
- Experience in planning and coordinating multi-disciplinary communications strategies, strategic initiatives, and events.
- Must respond and follow through to requests from customers promptly.
- Must work carefully and precisely with attention to detail.
- Must utilize resources wisely.
- Performs duties willingly and with initiative. Shares necessary information so co-workers can do the same.
- Cooperates with other departments and work groups.
EDUCATION:
Minimum: H.S. Diploma/GED
Desired: Medical Office Experience
YEARS OF EXPERIENCE:
Less than 2 years of experience in healthcare, customer service, or other related field
LICENSES AND CERTIFICATIONS:
N/A
FLSA Status:
Non-ExemptRight Career. Right Here. If you have a passion for taking care of the community and are interested in Healthcare, you will take pride in the level of care we provide at St. Elizabeth. We take care of patients and each other.
