Preauthorization and Referral Assistant

Beloit Health System•Beloit, WI

5d•Onsite

About The Position

Beloit Health System is looking to add a Preauthorization & Referral Assistant to our Insurance & Billing team! The Preauthorization and Referral Assistant will be responsible for obtaining prior authorizations and referrals for procedures, admissions, tests, and medications. Promptly responds to inquiries and requests for assistance from providers, staff, patients, payers, and/or employers via telephone, by mail, or in person. Obtains and verifies pertinent medical information and insurance information via the billing/medical record system. Assists provider with prior authorization/referral of drugs, including contacting Payers, patient, completing forms and keeps provider updated during this process. Contacts patient Payer(s) regarding preauthorization and/or second opinion requirements prior to procedures, hospital admissions, and tests to assure reimbursement for charges incurred for these services. Reviews daily hospital schedules to confirm that all required preauthorization have been completed and notifies provider appropriately. Documents pertinent details in the Practice Management System. Uses work queues to identify and work claims in various states of transmission and ensures they are worked in a timely manner. Maintains a working knowledge of Payer rules. Utilizes available Payer websites to complete authorizations and referrals. Demonstrates ability to perform functions accurately and efficiently with computer software. Interacts in a positive, responsible and cooperative manner with patients, Providers, co-workers and managers.

Requirements

High School graduate or equivalent.
Initiative and sound judgment.
Excellent organizational, verbal communication and interpersonal relation skills to be utilized with providers, patients, public staff and payers.
Knowledge of medical terminology, previous insurance experience, or Medical Assistant experience.
Excellent computer skills, with MS Word and Excel preferred.
Must adhere to established regulatory agencies, Beloit Health System, and department policies, rules and regulations.
Maintain ethical conduct and keep confidential personal, financial and medical information about patients.

Responsibilities

Obtaining prior authorizations and referrals for procedures, admissions, tests, and medications.
Promptly responding to inquiries and requests for assistance from providers, staff, patients, payers, and/or employers via telephone, by mail, or in person.
Obtaining and verifying pertinent medical information and insurance information via the billing/medical record system.
Assisting providers with prior authorization/referral of drugs, including contacting Payers, patient, completing forms and keeping the provider updated during this process.
Contacting patient Payer(s) regarding preauthorization and/or second opinion requirements prior to procedures, hospital admissions, and tests to assure reimbursement for charges incurred for these services.
Reviewing daily hospital schedules to confirm that all required preauthorization have been completed and notifying the provider appropriately.
Documenting pertinent details in the Practice Management System.
Using work queues to identify and work claims in various states of transmission and ensuring they are worked in a timely manner.
Maintaining a working knowledge of Payer rules.
Utilizing available Payer websites to complete authorizations and referrals.
Demonstrating ability to perform functions accurately and efficiently with computer software.
Interacting in a positive, responsible and cooperative manner with patients, Providers, co-workers and managers.