REFERRAL & AUTHORIZATION SPECIALIST

Covenant HealthCare•Saginaw, MI

22h•Onsite

About The Position

The Referral & Authorization Specialist provides administrative support to manage prior authorization requests, verifying insurance coverage, and scheduling appointments while ensuring compliance with HIPAA regulations and adhering to confidentiality standards when working with patients. Demonstrates excellent customer service performance in that his/her attitude and actions are at all times consistent with the standards contained in the Vision, Mission and Values of Covenant HealthCare and the commitment to Extraordinary Care for Every Generation.

Requirements

High School diploma and/or equivalent required, AND a successful completion of a competency-based Medical Assistant (MA) training program required. OR One (1) year experience in clinical (direct patient care) and/or medical (administrative patient support) required.
Knowledge of proper release of information standards.
Excellent oral communication and interpersonal skills.
Excellent organization, time management skills and attention to detail.
Proficiency with basic computer and typing skills.
Ability to remain calm in stressful/difficult situations while demonstrating sensitivity and compassion in all patient interactions.
Ability to work independently or as part of a team.
Ability to maintain confidential information.

Responsibilities

Answer and return phone calls promptly to patients, insurance companies, central scheduling, and physicians.
Manage and process prior authorization requests efficiently to ensure timely patient care.
Review and interpret medical records, documentation, and provider notes for authorization and scheduling purposes.
Collaborate with insurance companies to obtain authorization for patient appointments and resolve any discrepancies. Sending documentation to insurance, entering authorization information into EPIC, and forwarding authorization to the appropriate department.
Maintain accurate and complete medical records in compliance with HIPAA regulations.
Perform insurance verification to confirm patient eligibility and benefits prior to scheduling or obtaining authorization.
Maintain physician schedules as well as make adjustments as cancellations occur. Ensure that the physician schedules are filled according to their guidelines.
Schedule patients into order based on physician preferences and/or work with physician to arrange preferred order. Patients identified as priority should be treated as such.
Utilize medical terminology effectively when communicating with providers, insurers, and patients.
Ensure all activities adhere to managed care policies and healthcare regulations.
Performs other duties as assigned.