Outpatient Referral & Authorization Representative-8111

Kingman Healthcare•Kingman, AZ

23h

About The Position

This position is responsible for financially clearing all outpatient referrals as ordered by the referring provider. Financial clearing includes but is not limited to, processing referrals within the provider EMR, verifying insurance eligibility and benefits, contacting patients to discuss coverage, obtaining authorization when necessary, maintaining statistical information regarding payers, communicating with providers and staff about denials, and documenting and scanning all communication into the referral and EMR. Provides guidance as needed to the department and provider office representatives when required. Establishes and maintains inter-departmental communication within the hospital and works closely with the Medical Office Coordinators regarding issues that arise affecting orders. Other duties as assigned.

Requirements

High school graduate/GED or 2-5 years healthcare experience in lieu of education requirement.
Six months or more of progressive work experience.
Ability to communicate effectively with others.
Manage multiple priorities and tasks.
Maintain attention to detail.
Knowledge of and ability to use computer hardware and software applications.

Nice To Haves

One-year hospital outpatient referrals and/or insurance verification experience preferred.
Knowledge of medical terminology, coding rules and guidelines preferred.

Responsibilities

Processes referrals within the provider EMR.
Verifies insurance eligibility and benefits.
Contacts patients to discuss coverage.
Obtains authorization when necessary.
Maintains statistical information regarding payers.
Communicates with providers and staff about denials.
Documents and scans all communication into referral and EMR.
Provides guidance to the department and provider office representatives.
Establishes and maintains inter-departmental communication within the hospital.
Works closely with Medical Office Coordinators regarding issues affecting orders.
Consistently demonstrates a willingness to assist co-workers in a courteous manner to support department efficiency.
Develops and maintains good human relations skills by practicing AIDET, KRMC’s values, and behavioral standards with employees, patients, medical staff, and visitors.
Maintains a positive attitude and functions as a team player.
Protects patient information and hospital financial reimbursement by inputting authorization information.
Verifies insurance and ensures that all notification/authorizations are completed in a timely manner, as well as ensuring patient services are a covered benefit.
Inputs notes pertinent to financial information to assist the billing department in claim payment.
Contacts the responsible party of outpatient referrals by telephone to advise of insurance coverage rates when insurance does not cover 100%; professionally advises the responsible party of payment requirements and follows hospital policy in establishing payment arrangements or advises other referral sources.
Contact is made before the referral is sent to the referring provider/department.
Meets productivity standards for working incoming referrals to schedule financially cleared outpatient visits in a timely manner.
Referrals should be processed within three (3) business days.
Authorization should be initiated within three (3) business days.
Maintains statistical information regarding payers and communicates this information routinely to the Outpatient Scheduling Center Supervisor/Manager.
Assists with education to Outpatient Scheduling Reps.
Completes all assigned duties, and other duties as assigned, accurately and in a timely manner.
Provides day-to-day leadership and supervision of Referrals and Authorization team members.
Trains and orients new hire reps.
Works with Supervisors to provide continuous training of existing staff.
Performs QA audits, works account checks, and responds to account denials.
Assists with staff to ensure appropriate coverage in the absence of the supervisor.
Participates in interviews for hiring new staff within the unit.
Provides feedback to supervisors for performance evaluations.
Identifies, supports, and manages process improvement initiatives for the team.
Collaborates with management to assist in the day-to-day operations of the team.