Referral & Authorization Specialist - Care Lane Hematology/Oncology Clinic

Glens Falls Hospital•Saratoga Springs, NY

7d•Onsite

About The Position

The Referral & Authorization Specialist is a vital member of the cancer treatment program at Glens Falls Hospital's Care Lane Hematology/Oncology Clinic. This role serves as the point person for managing insurance authorizations and referrals, supporting the team by obtaining authorizations from providers and payers while ensuring all reimbursement requirements are met. The position also involves improving the patient experience by addressing insurance coverage and reimbursement questions and concerns. This is a full-time daytime role with on-the-job training available, offering opportunities for career growth and advancement for individuals with backgrounds in patient registration, customer service, and insurance processing. The work directly supports vital administrative functions related to cancer and hematology care and treatment, contributing to the health of the community.

Requirements

High school diploma/GED equivalent required
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
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

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