Referral & Prior Authorization Specialist
About The Position
At Saratoga Hospital, we've built a reputation for high-quality, compassionate care and a commitment to the health and well-being of our community. As part of the Albany Med Health System, we combine advanced technology with a deeply personal approach-creating a supportive environment for patients, staff, and providers alike. We believe that exceptional care starts with exceptional people. We're looking for a dedicated Referral & Prior Authorization Specialist to join our team and help us continue delivering the level of care our patients and families deserve. In this role, you'll be a vital part of our administrative team, ensuring excellent service, collaboration, and patient outcomes in a fast-paced healthcare environment. The Referral and Prior Authorization Specialist is responsible for obtaining referrals and authorizations to ensure reimbursement for services and testing provided throughout Saratoga Hospital Medical Group (SHMG). Demonstrates excellent communication, strong customer service, critical thinking, and problem solving skills. Completes all appropriate forms, applications, and necessary information. Accurately manages the referral and authorization process. Able to secure authorization and necessary documentation to ensure patient care is not impacted and meets time-sensitive requests. Is pro-active in troubleshooting instances which could result in great financial loss. Demonstrates excellent customer service skills and works in a positive manner for collaboration and clear communication between providers, staff, insurers, and families. The specialist works closely with the appropriate clinical team members for information gathering and patient data. Meets turnaround expectations for the majority of prior authorization approvals.
Requirements
- High school graduate or GED.
- At least two years in a medical office or insurance company environment, experience with prior authorizations and referrals required.
- Strong communication and teamwork skills
- Commitment to providing patient-first, high-quality service.
- Comfort working in a fast-paced, collaborative environment.
Nice To Haves
- Medical terminology certificate preferred.
Responsibilities
- Processes all referrals and authorizations received.
- Completes prior authorizations and referrals as required for services and testing.
- Collaborates with clinical team members, physician offices and agencies to ensure than an accurate and timely referral/authorization is processed and documented in accordance with department guidelines.
- Manages and maintains the Electronic Referral Tracking Report for accuracy of information, urgency, and other designated criteria.
- Acts as a resource to all internal and external customers, offering guidance and support for referral and authorization related questions and referral/authorization processing problems. Ensures patients receive timely and courteous communications.
- Informs referring providers when a requested service authorization request is denied.
- Stays current with the insurance authorization requirements by utilizing the resource library of payor benefit-specific information and provider contact information.
- Enters referrals and authorizations into the system per standardized practice protocols and provides feedback to ordering provider and parent/patient in a timely manner.
- Documents and provides updates in the patient's medical record, the status of the referral and/or authorization.
- Communicates and provides feedback to providers and staff regarding changes, trends, and processes.
- Referral and Authorization Specialists will be cross-trained to support inbound phones as needed.
Benefits
- Supportive leadership that invests in your development and well-being
- Comprehensive benefits, including medical, dental, retirement plans, tuition assistance, and wellness programs.
- Opportunities to grow within the Albany Med Health System
- Located in beautiful Saratoga Springs, known for its vibrant community, outdoor recreation, and cultural attractions
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Industry
Hospitals
Education Level
High school or GED
