Referral and Authorization Specialist - Hemetology/Oncology (Flexible scheduling options for Per-Diem positions)

Glens Falls Hospital•Glens Falls, NY

1d•$18 - $27

About The Position

The Impact You Can Make Team Impact The Referral and Authorization Specialist is responsible for obtaining authorizations as required from providers and payers to ensure all reimbursement requirements are met. The Glens Falls Hospital Impact Mission Our Mission is to improve the health of people in our region by providing access to exceptional, affordable, and patient-centered care every day and in every setting. How You Will Fulfill Your Potential Responsibilities ESSENTIAL FUNCTIONS Verify patient insurance eligibility & coordination of benefits. Prepare and compile necessary documentation to secure prior authorization. Collect clinical information regarding service to be rendered as applicable (J codes, CPT codes, ICD codes, Units) as well as medical records Interviews patients to apprise them of their insurance benefits contingent on the type of procedure / level of care to secure collection of patient financial obligations / secure payment arrangements Contact provider / payer to obtain prior authorization. Gather additional clinical and / or coding information as necessary in order to obtain prior authorization Maintain ongoing tracking and appropriate documentation of referrals & authorizations. Verify that all insurance requirements for procedures and admissions have been met. Verify via website or telephone that the authorization number(s) provided by providers are correct, that the location authorized is appropriate for the patients encounter and location, and verify validity dates. Ensure that services ordered are within benefit plan and approved for procedure / testing point of service as appropriate Verify medical necessity guidelines are met. Take appropriate action as necessary when guidelines are not met Monitor patient length of stay to ensure adequate coverage. Secure authorization for extended stay / set up payment arrangements as appropriate Provide follow up when insurance denials are received. Provide required documentation or information requested by insurers to facilitate payment Develop thorough knowledge of all medications / procedures performed and payer authorization requirements for each Understand insurance requirements for prior authorization / authorization. Serve as primary resource to Glens Falls Hospital staff regarding authorization requirements Serve as principal contact for clinical and / or department staff regarding prior authorization / authorization process for services to be rendered at Glens Falls Hospital or Glens Falls Hospital Health Centers Advise providers and their clinical staff when issues arise relating to obtaining prior authorization Stay informed and research information regarding new procedures and insurance coverage requirements Interact directly with providers and / or their clinical staff as necessary OTHER FUNCTIONS Assist with the registration of patients when / if needed Assist with cashier duties / responsibilities when / if needed

Requirements

High School Diploma or Equivalent
Ability to type 60 WPM
Knowledge of CPT and ICD coding desired
Knowledge of Medicare and third party payer regulations desired
Ability to multitask and meet deadlines
Ability to problem solve and work independently
Strong organizational skills, effective interpersonal skills

Nice To Haves

Associates Degree or four (4) years of insurance experience in a healthcare environment preferred

Responsibilities

Verify patient insurance eligibility & coordination of benefits.
Prepare and compile necessary documentation to secure prior authorization.
Collect clinical information regarding service to be rendered as applicable (J codes, CPT codes, ICD codes, Units) as well as medical records
Interviews patients to apprise them of their insurance benefits contingent on the type of procedure / level of care to secure collection of patient financial obligations / secure payment arrangements
Contact provider / payer to obtain prior authorization.
Gather additional clinical and / or coding information as necessary in order to obtain prior authorization
Maintain ongoing tracking and appropriate documentation of referrals & authorizations.
Verify that all insurance requirements for procedures and admissions have been met.
Verify via website or telephone that the authorization number(s) provided by providers are correct, that the location authorized is appropriate for the patients encounter and location, and verify validity dates.
Ensure that services ordered are within benefit plan and approved for procedure / testing point of service as appropriate
Verify medical necessity guidelines are met.
Take appropriate action as necessary when guidelines are not met
Monitor patient length of stay to ensure adequate coverage.
Secure authorization for extended stay / set up payment arrangements as appropriate
Provide follow up when insurance denials are received.
Provide required documentation or information requested by insurers to facilitate payment
Develop thorough knowledge of all medications / procedures performed and payer authorization requirements for each
Understand insurance requirements for prior authorization / authorization.
Serve as primary resource to Glens Falls Hospital staff regarding authorization requirements
Serve as principal contact for clinical and / or department staff regarding prior authorization / authorization process for services to be rendered at Glens Falls Hospital or Glens Falls Hospital Health Centers
Advise providers and their clinical staff when issues arise relating to obtaining prior authorization
Stay informed and research information regarding new procedures and insurance coverage requirements
Interact directly with providers and / or their clinical staff as necessary
Assist with the registration of patients when / if needed
Assist with cashier duties / responsibilities when / if needed

Benefits

Glens Falls Hospital is committed to providing our people with valuable and competitive benefits offerings, as it is a core part of providing a strong overall employee experience. A summary of these offerings, which are available to active, full-time and part-time employees who work at least 30 hours per week, can be found here .

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