Referral & Prior Auth Rep III

Oversees data and ensures compliance to enterprise standards and referral and prior authorization guidelines. Communicates regularly with patients, families, clinical and non-clinical staff, identifying barriers to appointment compliance, insurance company barriers and tracking all assistance provided. Plans, executes, appeals and follows through on all aspects of the process which has direct, multifaceted impact on patient scheduling, treatment, care and follow up.

Responsibilities

Oversees data and ensures compliance to enterprise standards and referral and prior authorization guidelines; Communicates regularly with patients, families, clinical and non-clinical staff; Plans, executes, appeals and follows through on all aspects of the referral/prior authorization process; Manages department referrals and serves as liaison, appointment coordinator, and patient advocate; Acquires insurance authorization for visits and testing; Documents communications in electronic health record; Prepares and provides complex details to insurance or worker's compensation carrier to obtain prior authorizations; Manages orders for patients being seen in ED/Urgent Care; Processes outgoing and incoming referrals; Performs other duties as assigned

Requirements

High School diploma or equivalent and 2 years of relevant experience; Equivalent combination of education and experience; Demonstrated customer relations skills

Nice to have

Medical Terminology; Experience with surgical/appointment scheduling software; Electronic medical records