Preauthorization and Referral Assistant
About The Position
Beloit Health System is looking to add a Preauthorization & Referral Assistant to our Insurance & Billing team! This role is responsible for obtaining prior authorizations and referrals for procedures, admissions, tests, and medications. The assistant will promptly respond to inquiries and requests for assistance from providers, staff, patients, payers, and/or employers via telephone, mail, or in person. They will obtain and verify pertinent medical and insurance information using the billing/medical record system, assist providers with prior authorization/referral of drugs by contacting Payers and patients, completing forms, and keeping the provider updated. The assistant will contact patient Payer(s) regarding preauthorization and/or second opinion requirements prior to procedures, hospital admissions, and tests to assure reimbursement. They will review daily hospital schedules to confirm all required preauthorizations have been completed and notify providers appropriately. Responsibilities also include documenting pertinent details in the Practice Management System, using work queues to identify and work claims in various states of transmission, maintaining a working knowledge of Payer rules, and utilizing Payer websites to complete authorizations and referrals. The role requires the ability to perform functions accurately and efficiently with computer software and to interact 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, patients, completing forms and keeping providers updated.
- 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 preauthorizations have been completed and notifying providers 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.
Benefits
- Eligible for benefits
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
