Authorization & Referral Specialist

Western Missouri Medical Center•Warrensburg, MO

5d•Onsite

About The Position

Verify and obtain authorizations as required by insurance companies depending on plan coverage for all patients. Complete registration and scheduling for the sleep center, including sleep studies and clinic visits.

Requirements

High school diploma or equivalent.
Computer and EMR experience.
Organizational skills.
Advanced typing skills.
Ability to communicate well with people in personal contact and telephone conversations.
Ability to effectively act as a liaison between patient and provider.
Ability to follow oral and written instructions.
Familiar with medical office practices and medical insurance.
Familiar with ICD-10, CPT, HCPCS codes.
Must be self-motivated and have the ability to work within the established policies, procedures, and practices prescribed by the hospital/clinic.

Nice To Haves

Minimum two years’ general office work experience.
Medical terminology.

Responsibilities

Verify and obtain authorizations required by insurance companies for patient services.
Complete registration and scheduling for the sleep center, including sleep studies and clinic visits.
Communicate with the Care Team and funding sources.
Manage time effectively and maintain organization.
Demonstrate critical thinking, creativity, problem-solving, and decision-making skills.
Maintain working knowledge of federal, state, local, and intermediary specific billing requirements to ensure appropriate authorizations are complete.
Notify appropriate personnel of missing or incomplete billing requirements and follow up in a timely manner.
Assist in educating the Care Team regarding authorizations and act as a resource.
Ensure all pre-authorizations are approved with the proper procedure code prior to service.
Stay knowledgeable of current changes in coding and reimbursement requirements for all billing payors.
Contact providers with authorization, denial, and appeals process information.
Research and resolve rejected, incorrectly paid, or denied claims in collaboration with patient success and billing departments.
Greet patients and visitors courteously and friendly.
Deal effectively with emotionally charged situations.
Perform insurance verifications daily.
Ensure all necessary documentation is completed prior to obtaining authorization.
Ensure all documentation required for authorization is obtained and forwarded to the proper entity.
Close the referral loop by ensuring all necessary documentation has been received.
Schedule patients for sleep studies once authorization is obtained.
Work from the referral pool to schedule visits in the clinic.
Register all sleep center patients.
Maintain regular and predictable attendance.
Perform other essential duties as assigned.