Prior Authorization and Referral Specialist
About The Position
Oregon Urology Institute has a Full-time, Prior Authorization and Referral Specialist opportunity available. Oregon Urology Institute is one of the largest, most advanced urological centers in the Northwest. Oregon Urology Institute provides patients with some of the region's finest medical experts covering every major urological specialty using proven and leading-edge technologies such as robotic surgery, immunotherapy, and radiation therapy. GENERAL DESCRIPTION This role will obtain all required authorizations prior to services being rendered at OUI and outside facilities. Verification of insurance coverage and benefits prior to service being rendered and request prepayment if applicable. Work denied claims.
Requirements
- Minimum of 1-3 years' experience working in a related medical office role.
- Working knowledge of healthcare insurance benefit, authorization, and reimbursement practices.
- Knowledge of CPT & ICD10 coding.
- Ability to review, understand and extract relevant information from EMR.
- Strong communication skills, both written and verbal
- Attention to detail and ability to multitask in a demanding environment.
- Ability to work both independently and as a team by prioritizing workload.
- Ability to research and analyze data to resolve issues
- Ability to make confident decisions while acting on behalf of OUI Physicians and patients.
Nice To Haves
- Experience working in a Windows based EMR/PM
- Desire to strengthen skills and learn.
- Must be flexible and adaptive learner.
Responsibilities
- Verify Insurance of all scheduled patients as needed.
- Perform benefit inquiries to determine estimated out of pocket expense.
- Notify patient of prepayment requirements and follow up as needed.
- Provide Good Faith Estimates and waivers to self-pay and out of network patients and discuss prepayment requirements.
- Learn and understand basic principles of Fee schedules and insurance contracts.
- Obtain and maintain Insurance portal logins
- Contact insurance carriers and third-party entities to obtain authorizations.
- Appeal denied Authorizations by working with OUI Providers, patients, and insurance companies.
- Stay current on insurance policies and practices for Authorizations and Benefits
- Communicate daily with other departments to ensure scheduled, add-on and future services are covered.
- Provide real-time verification, benefit, and coverage support for Urgently added services.
- Continuously monitor schedules, reports, and messaging systems to ensure Authorization and coverage remains valid for any rescheduled service.
- Maintain positive relationships with Scheduling, Reception, Clinical Staff including Physicians, Management, and outside entities.
- Communicate with outside medical offices and Facilities to ensure coverage for referred services.
- Review and take corrective action on rejected and denied claims in a timely manner.
- Assist in training new staff and continued support of team members.
- Review and ensure accurate information in additional software programs (EZ Access, etc.)
- Perform other duties and special projects as assigned by Supervisor or Manager
- Maintain strict Confidentiality
Benefits
- fully employer paid life, health, dental and vision
- 6 paid holidays
- generous PTO
- voluntary benefits
- an outstanding retirement
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
No Education Listed
