Referral & Authorization Specialist

North Florida Surgeons, P.A.•Niceville, FL

4d•Onsite

About The Position

The Referral & Authorization Specialist is responsible for coordinating and managing all patient referrals and insurance authorizations for Bluewater Orthopedics. This position plays a critical role in ensuring patients have the necessary referrals and authorizations prior to their appointments, procedures, and diagnostic imaging. The Referral & Authorization Specialist must maintain accurate and timely documentation, communicate effectively with insurance companies and primary care offices, and ensure that all required information is properly entered into the patient’s chart and distributed to the appropriate facilities. This position requires excellent organization, attention to detail, follow-through, and the ability to manage multiple tasks and deadlines across all Bluewater Orthopedics locations.

Requirements

Strong computer and data-entry skills.
Excellent attention to detail and accuracy.
Strong organizational and time-management skills.
Ability to prioritize multiple tasks and meet deadlines.
Professional and effective communication skills.
Ability to communicate with patients, insurance companies, primary care offices, imaging facilities, and healthcare providers.
Ability to work independently while also functioning effectively as part of a team.
Ability to maintain confidentiality and comply with HIPAA requirements.

Nice To Haves

Previous experience in medical referrals, prior authorizations, insurance verification, scheduling, or a medical office environment.
Knowledge of insurance referral and authorization requirements.
Experience working with electronic medical records.

Responsibilities

Complete and manage referrals for all Bluewater Orthopedics offices and providers.
Review patient schedules and identify patients who require referrals.
Request referrals from primary care provider offices when necessary.
Follow up with primary care offices to obtain pending referrals.
Verify that referrals are current, valid, and applicable to the patient’s scheduled visit.
Accurately enter referral information into the appropriate systems and the patient’s chart.
Attach referrals to the appropriate appointments/orders.
Monitor outstanding referrals and follow up as needed to prevent delays or missed appointments.
Maintain referral information in an organized and up-to-date manner.
Obtain insurance authorizations for services requiring prior authorization.
Request authorization from primary care offices, insurance companies, or other appropriate entities.
Complete and submit authorization requests accurately and within required timeframes.
Monitor pending authorizations and follow up regularly until a determination is received.
Verify authorization dates, approved services, number of visits/units, and other applicable requirements.
Accurately document authorization information in the patient’s chart and applicable systems.
Ensure completed authorizations are attached to the appropriate orders and patient records.
Complete authorization requests for diagnostic imaging ordered by Bluewater Orthopedics providers.
Obtain necessary authorization information from insurance companies and/or referring providers.
Monitor imaging authorization requests through completion.
Verify that the authorization matches the requested imaging study, body part, facility, and applicable dates.
Attach completed imaging authorizations to the appropriate orders.
Distribute imaging orders and authorization information to the designated imaging facility.
Ensure imaging facilities receive all necessary documentation in a timely manner.
Follow up on outstanding imaging authorizations to prevent delays in patient care.
Schedule patients when appropriate based on referral, authorization, and provider requirements.
Review upcoming schedules to identify missing referrals or authorizations.
Communicate with patients regarding referral and authorization requirements when necessary.
Assist with resolving scheduling issues related to referrals, authorizations, and imaging.
Communicate with providers, clinical staff, primary care offices, insurance companies, and outside facilities as needed.
Accurately enter patient demographic, insurance, referral, and authorization information.
Maintain accurate and complete documentation within the electronic medical record and other applicable systems.
Ensure all referral and authorization information is attached to the correct patient, appointment, order, or encounter.
Protect patient confidentiality and follow all HIPAA and Bluewater Orthopedics policies and procedures.
Review work regularly to ensure information is current and accurate.
Maintain all referral, authorization, and imaging authorization tasks in an organized and current status.
Review outstanding tasks daily and prioritize items based on upcoming appointments and urgency.
Ensure no referral or authorization request remains unattended or unnecessarily delayed.
Follow up proactively with insurance companies, primary care offices, imaging facilities, and other entities.
Communicate potential delays or issues to management and appropriate clinical staff.
Maintain accurate records of pending, approved, denied, and completed referrals and authorizations.
Ensure all assigned responsibilities remain up to date.
When needed, provide coverage and support for the front desk, including checking patients in and out, verifying and updating patient demographic and insurance information, collecting copays and other applicable patient balances, answering phones and assisting patients with general questions, assisting with scheduling and rescheduling appointments, and providing general front desk support to maintain smooth clinic operations.