Referral and Prior Authorization Specialist

SUNTREE INTERNAL MEDICINE LLC•Melbourne, FL

3d•$15 - $16•Onsite

About The Position

The Medical Referral and Prior Authorization Specialist is responsible for processing referral requests, gathering necessary patient and medication information, ensuring accuracy of forms, utilizing specific systems for prior authorizations, and communicating with patients regarding the status of their referrals. This role also involves obtaining necessary authorizations for specialist visits or procedures and potentially working on lab rebills. The specialist will transmit information and analyze data to answer patient questions.

Requirements

High School Diploma or GED required
Medical Terminology Knowledge required
High-level of multi-tasking
Time management skills
Medical Terminology
Team player
Follow step-by-step procedures
Personable
Requires full range of body motion including handling and lifting of patients, manual and finger dexterity, and hand-eye coordination.
Requires standing and walking for extensive periods of time
Occasionally lifts and carries items weighing up to fifty (50) pounds
Requires corrected vision, hearing, and speech within normal ranges
Requires working under stressful conditions and sometimes irregular hours
Potential contact with bloodborne pathogens, bodily secretions, etc.
Must pass a level 2 background screening PRIOR to joining Suntree Internal Medicine.

Nice To Haves

Medical Experience preferred

Responsibilities

Process referral requests made by providers.
Gather medication information: quantity, diagnosis, dosages, directions.
Gather patients current insurance information.
Ensure accuracy of forms and clinical questions per insurance company.
Utilize the covermymeds system for medication prior authorizations and keeping the requests cleaned up.
Enter requests into the DASH system and compile referrals and records to be sent to the specialist office ensuring that the provider we send a patient to accepts the insurance the patient has.
Communicate with the patientsthe status of any referrals or prior authorizations sent on a patient’s behalf.
Obtain authorizations as required for patients to see specialists or procedures that they ordered as necessary.
Work on lab rebills as needed.
Transmit information or documents to customers, using a computer, mail, or facsimile machine.
Analyze data to determine answers to questions from patients.