Authorization-Referral Specialist, IPN, Full Time

Iredell Memorial Hospital Incorporated•Statesville, NC

just now

About The Position

The Authorization- Referral Specialist will be responsible for managing the procurement of pre-authorizations, estimations, and/or referrals by practices and other facilities, for potential services that are scheduled at an Iredell Health location. Including verifying, retrieving, and updating the patient’s major medical health plan benefits; and documenting this information in the hospital’s health care technology system.

Requirements

High School graduate or GED.
Minimum 2 years’ experience in a health coordination role, preferred
Demonstrated understanding of industry guidelines and best practices.
Thorough understanding of insurance coverage and Medical Necessity policies, desired.
Customer service experience required.
Strong attention to detail, analytical skills, and ability to work independently.
Ability to operate a computer, basic office equipment and multi-line telephone system.
Must be well organized, detail oriented, and obtain excellent communication skills.
Must possess full range of body motion to pass basic FIT test for position to include walking, kneeling, standing, pushing, pulling, bending, stooping, reaching and sitting for extended periods of time.
Must be able to lift and carry up to 25 pounds
Manual dexterity needed for using a calculator and computer keyboard.

Nice To Haves

Minimum 2 years’ experience in a health coordination role, preferred
Thorough understanding of insurance coverage and Medical Necessity policies, desired.

Responsibilities

Verify that all required pre-authorizations, estimations, and/or referrals have been completed by practices and other facilities and that they have been assigned to the correct department.
Responsible for prioritizing Stat pre-authorizations, estimations, and/or referrals.
Follow up on sent pre-authorizations, estimations, and/or referrals.
Review patient benefits and eligibility to communicate with clinician and clinical staff pertaining to pre-authorizations, estimations, and/or referrals.
Keep the system up to date with any changes in information.
Manage pre-authorization, estimation, and/or referral status to ensure Iredell Health location(s) have all updated and current information.
Obtains and maintain pre-authorizations, estimations, and/or referrals for diagnostic and ancillary testing.
Handle sensitive information in a confidential manner.
Verifies insurance coverage and patient demographics, when necessary.
Communicates as needed with health care professionals and clinic staff to clarify diagnoses or obtain additional information.
Updates registration documentation to ensure that information is complete and filed appropriately.
All other duties as assigned.