Referral & Authorization Specialist - Care Lane Hematology/Oncology Clinic

Glens Falls Hospital • City of Saratoga Springs, NY

9d • Onsite

About The Position

Attention all clerical and administrative professionals with a background in insurance! Our Care Lane Hematology/Oncology Clinic is looking to help you advance your healthcare career at Glens Falls Hospital. Come join our team of insurance experts as the Referral & Authorization Specialist! This position can further develop your skills in compliance, medical billing, customer service, and Health Information Management (HIM). If you are looking to make an impact with your work, we want to hear from you today! In this position, you will be a vital member of the cancer treatment program by serving as the point person for managing insurance authorizations/referrals. You will closely support this team by obtaining authorizations from providers and payers while ensuring all reimbursement requirements are met. You will help to improve the overall patient experience by using your customer service skills and insurance expertise to help our patients and their families address any questions/concerns they may have related to insurance coverage and reimbursement requirements.

Requirements

• High school diploma/GED equivalent required
• Excellent computer, phone and customer service skills required
• Excellent written and verbal communication skills required
• Ability to multitask and meet deadlines
• Ability to problem solve, trouble shoot issues as they arise, and work independently
• Ability to type 60 WPM
• Strong organizational skills required

Nice To Haves

• Successful completion of an AAS in health administration, business, finance, or related field preferred
• Four (4) years of insurance experience in a healthcare environment preferred in lieu of an associate degree
• Baseline knowledge of medical terminology preferred
• Knowledge of CPT and ICD coding desired
• Knowledge of Medicare and third-party payer regulations desired

Responsibilities

• Verify patient insurance eligibility & coordination of benefit
• Prepare and compile necessary documentation to secure prior authorization.
• Collect clinical information regarding service to be rendered as applicable (as well as medical records)
• Interview patients to apprise them of their insurance benefits, contingent on the type of procedure/ level of care with a goal of securing the 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 while verifying all insurance requirements for procedures and admissions have been met
• Monitor patient waiting areas for extended wait times and patient related problems
• Use a multitude of sources to ensure that the authorization number(s) provided by providers are correct, and that the location/dates authorized are appropriate for the patients encounter/location
• Ensure that services ordered are within benefit plan and approved for procedure / testing point of service as appropriate
• Verify medical necessity guidelines are met and take appropriate action as needed when guidelines are not met
• Monitor patient length of stay to ensure adequate coverage and secure authorization for extended stay / set up payment arrangements as appropriate
• Provide follow up when insurance denials are received and 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. and serve as primary resource to 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

Benefits

• On the job training available to ensure career growth and success
• Great opportunity for advancement for those with a background in patient registration, customer service, and insurance processing

What This Job Offers

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