Referral & Authorization Specialist

Western Reserve • Cuyahoga Falls, OH

3d

About The Position

Function as a liaison between physicians and patients in the processes of obtaining authorizations for tests, diagnostic imaging, DME, and referrals to other providers. Is responsible for communication with patients, and processing referral in EMR. Also responsible for determining insurance eligibility and ensuring that all payor requirements are met for authorizations and insurance processing.

Requirements

• High school diploma or equivalent required.
• Two (2) years of experience in medical insurance verification or other hospital finance areas required.
• Prior authorization experience required.
• Knowledge of authorization or referral verification requirements for Medicare, Medicaid, commercial insurance, managed care plans, workers compensation and other third-party payors required.

Responsibilities

• Function as a liaison between physicians and patients in the processes of obtaining authorizations for tests, diagnostic imaging, DME, and referrals to other providers.
• Responsible for communication with patients.
• Processing referral in EMR.
• Determining insurance eligibility.
• Ensuring that all payor requirements are met for authorizations and insurance processing.

What This Job Offers

• Career Level: Mid Level
• Education Level: High school or GED
• Number of Employees: 251-500 employees