Referrals and Authorization Specialist

Martin's Point Health Care • Portland, ME

15h

About The Position

The Referral and Authorization Specialist plays a key role in ensuring patients at Martin’s Point Health Care receive timely and coordinated care. As a part of the Centralized Services team, this position works collaboratively with the health care centers, and health plans to manage the end-to-end referral and authorization process. The specialist acts as a liaison between internal providers, external specialists, pharmacies, and facilities to ensure that all referrals, pre-certifications, and prior authorizations are accurately processed in support of quality care delivery.

Requirements

• HS Diploma or equivalent
• 3+ years’ experience working in a medical environment with patient registration, billing, insurance processing or appointment scheduling
• Knowledge Medical terminology
• Strong organizational, communication, and customer service skills.
• Ability to work collaboratively in a fast-paced, team-oriented environment.
• Knowledge of payer authorization and referral requirements
• Basic computer skills: Word, Excel, etc.
• Positive interpersonal skills
• Collaborative
• Strong attention to detail
• Ability to handle difficult conversations with patients and internal customers
• Problem solving
• Customer focused approach

Nice To Haves

• Referral or authorization experience preferred
• Athena experience

Responsibilities

• Responsible for the processing and management of patient referrals, prior authorizations, and ancillary orders to/from specialists, insurance carriers, and facilities
• Coordinates and communicate with internal care teams to ensure timely handling of referral requests.
• Obtains required prior authorizations and pre-certifications from health plans in compliance with payer guidelines.
• Complies with all service standards, organizational policy and standard operating procedures for the processing and management of all patient referrals and prior authorizations.
• Ensures accurate documentation and tracking of all referral and authorization activities in EHR.
• Monitors referral or authorization status and follow up with providers or health plans as needed to avoid delays in care.
• Serves as a resource for patients and care teams regarding referral and authorization processes.
• Maintains confidentiality and comply with HIPAA regulations and organizational policies.
• Communicates updates from specialty partners in the community with staff and providers.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED