About The Position

This position is responsible for processing referral requests for all providers practicing within the clinic module and ensuring that when needed, referral/authorization numbers are obtained for these services. Access to specialty and ancillary testing services is a key component for the treatment of our patients and the satisfaction of our referring providers. The responsibilities of this position are extremely important in meeting or exceeding customer satisfaction.

Requirements

  • High School or GED (Required)
  • Excellent customer service and organizational skills
  • Ability to communicate effectively, both written and orally
  • Strong typing and computer skills with the ability to multi task in a fast paced environment
  • Working knowledge of ICD-9 and CPT-4 classification systems, Anatomy & Physiology, Medical Terminology, inpatient and outpatient services
  • 1-2 years working knowledge while obtaining referral, medical authorizations in a healthcare facility interacting regularly with insurance representative, physician office or patient via telephone
  • Minimum of 2 years Experience in a physician office with extensive patient registration, front desk and insurance Experience and knowledge required
  • One years Experience with third party payors required
  • Computer Experience required

Responsibilities

  • Search electronic medical records to obtain the required clinical information needed for medical authorization. Provides all necessary information medical records, scripts, et c to payer.
  • Reviews, Obtains & Processes all diagnostic/specialty/miscellaneous referral and authorization requests for both provider and facility.
  • Handles calls from internal and external sources where prioritization and time sensitive action is required.
  • Communicates with all involved, payer, provider, patient as appropriate and as per protocol. Provides a standard of excellence as it relates to customer service and satisfaction for all customers.
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