Referral and Authorization Specialist

Roosevelt General Hospital•Portales, NM

About The Position

Under general supervision, is responsible for representing Roosevelt General Hospital (RGH) as an exemplary hospital/clinic in the region. Referral and Authorization Specialist will be the embodiment of the hospital’s mission, vision and values. They will greet patients, families and hospital guests upon arrival and assist them in navigating through all aspects of their hospital visit. The position is responsible for coordinating any additional care the patient may need inside and outside of our facility. The position is responsible for obtaining prior authorization needed for testing or services.

Requirements

High school graduate or equivalent
Ability to communicate effectively
Knowledge of medical procedures and medical terminology
Basic to intermediate computer knowledge
One year of medical office experience required
Typing speed: minimum 40 wpm, computer knowledge
Adhere to dress code, appearance is neat and clean.
Complete annual education requirements.
Maintain patient confidentiality at all times.
Report to work on time and as scheduled.
Wear identification while on duty.
Maintain regulatory requirements, including all state, federal and local regulations.
Represent the organization in a positive and professional manner at all times.
Comply with all organizational policies and standards regarding ethical business practices.
Communicate the mission, ethics and goals of the organization.
Participate in performance improvement and continuous quality improvement activities.
Attend regular staff meetings and in-services.
Knowledge of medical insurances (Medicare, HMO’s, PPO’s, commercial), EMTALA regulations, hospital billing and collection process
Must have an enthusiastic and positive attitude
Possess a genuine desire to help RGH become an exemplary hospital in the surrounding community and the state
Ability to work independently, exercise creativity, be attentive to detail, and maintain a positive attitude
Ability to manage multiple and simultaneous responsibilities and to prioritize duties/tasks
Ability to initiate communication with patients, their families and hospital visitors
Must have excellent customer service and communication skills with the ability to effectively calm patients and be able to deal with distressed and/or agitated patients and their families
Must have a professional demeanor and excellent public relations skills
Willingness to develop or improve public speaking skills
Must have excellent written skills with knowledge of medical terminology
Must be dependable and on time
Possess good 'people skills' for building relationships with colleagues at all levels
Ability to plan and prioritize workload to meet deadlines

Nice To Haves

Spanish speaking is preferred
Previous customer service experience preferred
Knowledge of CPT / ICD- coding helpful.

Responsibilities

Promote the mission, vision, and values of the organization
Greet all patients, families and hospital visitors with a positive, cheerful attitude.
Notifies the client of appointments scheduled, makes follow-up calls to off-site Providers to ensure that client kept appointment and reminds Provider to submit a Consultation Report.
Maintains competency in obtaining and inputting medical information to and from clinical and /or other information systems including accessing information as required to complete the referral process
Screen and schedule incoming and outgoing referrals
Obtain prior authorization for diagnostic services and procedures.
Answers questions from patients, clerical staff, and insurance companies
Establish and maintain relationships with identified server providers
Utilizes software to code ICD- and CPT codes
Contact customers to obtain or relay account information
Be knowledgeable on all of RGH services
Serve as the main communications person for the department, answering and placing phone calls, taking and relaying messages for clinical staff
Assist other members of the department as needed.
Performs other duties as assigned.