Referral Authorization Specialist

LifePoint Health • Sierra Vista, AZ

99d

About The Position

The Referral Authorization Specialist is responsible for ensuring that patients are getting the care that they need in a timely manner. This will involve processing referrals in a complete, accurate, and timely manner, verifying that patients have received the care they require, and notifying providers if patients do not follow through with referrals.

Requirements

• High school diploma or equivalent required.
• Two years of college preferred.
• Requires critical thinking skills, decisive judgment, and the ability to work with minimal supervision.
• Must be able to work in a stressful environment and take appropriate action.

Responsibilities

• Completes pre-authorizations for all diagnostic testing, therapy, surgical and specialty care appointments according to insurance requirements within 3 days of issuance.
• Notifies patient when referral is approved and notifies Provider if denied or if a second opinion or additional information is required.
• Documents all communication with patient, nurse, and/or Provider in the clinic EMR.
• Updates referrals in the EMR each time communication occurs with patient, insurance provider, nurse, or Provider.
• Maintains up-to-date knowledge of all health care plans and interprets and communicates plan policies and procedures to employees, physicians, and patients when they have changed.
• Identifies and attempts to resolve patient's barriers to specialty care, including assisting with scheduling appointments and helping to coordinate with specialist offices.
• Assists in tracking high-priority referrals to ensure patients in high-risk categories receive necessary follow-up care.
• Under the supervision of physician or nurse, assists with performing patient assessments and treatments.
• Performs administrative or clerical duties as assigned, including filing, reception, scheduling, data entry, and patient registration.

Benefits

• Health (Medical, Dental, Vision) and 401K Benefits for full-time employees
• Competitive Paid Time Off
• Employee Assistance Program - mental, physical, and financial wellness assistance
• Tuition Reimbursement/Assistance for qualified applicants

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Hospitals
• Education Level: High school or GED