Pre-Authorization Referral Specialist
About The Position
Responsible for verifying eligibility, obtaining insurance benefits, and ensuring pre-certification, authorization, and referral requirements are met prior to the delivery of inpatient, outpatient, and ancillary services. This individual determines which patient services have third party payer requirements and is responsible for obtaining the necessary authorizations for care, via phone, fax, or payer websites. The Specialist provides detailed and timely communication to both payers and clinical partners in order to facilitate compliance with payer contractual requirements and is responsible for documenting the appropriate information in the patient's record. Other duties as assigned.
Requirements
- High School Degree or Equivalent
- 1 year of work experience
- Ability to perform job functions while standing (Frequent)
- Ability to perform job functions while sitting (Frequent)
- Ability to perform job functions while walking (Frequent)
- Ability to work from elevated areas (Frequent)
- Ability to bend at the waist (Frequent)
- Ability to perform repetitive motions with hands/wrists/elbows and shoulders (Frequent)
- Ability to reach in all directions (Frequent)
- Possess good finger dexterity (Continuous)
- Ability to fully use both legs (Continuous)
- Ability to fully use both hands/arms (Continuous)
- Ability to maintain 20/40 vision, corrected, in one eye or with both eyes (Continuous)
- Ability to see and recognize objects close at hand or at a distance (Continuous)
- Ability to match or discriminate between colors (Continuous)
- Ability to determine distance/relationship between objects; depth perception (Continuous)
- Ability to maintain hearing acuity, with correction (Continuous)
- Ability to perform gross motor functions with frequent fine motor movements (Continuous)
- Ability to work in a latex safe environment (Continuous)
- Ability to maintain tactile sensory functions (Frequent)
- Ability to maintain good olfactory sensory function (Frequent)
- Ability to be qualified physically for respirator use, initially and as required (Continuous)
Nice To Haves
- Ability to climb stairs (Infrequent)
- Ability to work in confined/cramped spaces (Infrequent)
- Ability to perform job functions from kneeling positions (Infrequent)
- Ability to squat and perform job functions (Infrequent)
- Ability to lift and carry 15 lbs. unassisted (Infrequent)
- Ability to lift/lower objects 15 lbs. from/to floor from/to 36 inches unassisted (Infrequent)
- Ability to lift from 36 inches to overhead 15 lbs. (Infrequent)
Responsibilities
- Verifying eligibility
- Obtaining insurance benefits
- Ensuring pre-certification, authorization, and referral requirements are met prior to the delivery of inpatient, outpatient, and ancillary services
- Determining which patient services have third party payer requirements
- Obtaining the necessary authorizations for care, via phone, fax, or payer websites
- Providing detailed and timely communication to both payers and clinical partners in order to facilitate compliance with payer contractual requirements
- Documenting the appropriate information in the patient's record
- Other duties as assigned
Benefits
- Participates in the federal E-Verify program to confirm the identity and employment authorization of all newly hired employees.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
