Referral Authorization Specialist

Lifepoint Health • Las Cruces, NM

1d

About The Position

The Referral Authorization Specialist is responsible for ensuring that patients are getting the care that they need in a timely manner, on a daily basis, 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 is required.
• 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.

Nice To Haves

• Two years of college preferred

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.
• All communication with patient, nurse, and/or Provider will be documented in the clinic EMR.
• Updates to referrals will be made in the EMR each time communication is had 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 resolves 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.
• Perform other duties as assigned.

Benefits

• Multiple levels of medical, dental and vision coverage for full-time and part-time employees.
• Life, accident, critical illness, hospital indemnity insurance, short- and long-term disability, paid family leave and paid time off.
• Higher education and certification tuition assistance, loan assistance and 401(k) retirement package and company match.
• Mental, physical, and financial wellness programs (free gym memberships, virtual care appointments, mental health services and discount programs).
• Ongoing learning and career advancement opportunities.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 101-250 employees