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. Adheres to approved protocols for working referrals and prior authorizations.

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 process; Manages department referrals and serves as liaison, appointment coordinator, and patient advocate; Acquires insurance authorization for visits and testing; Prepares and provides complex details to insurance or worker's compensation carrier to obtain prior authorizations; Processes outgoing referrals and ensures Summary of Care is transferred electronically via Epic; Processes incoming referrals not generated within the UR system

Requirements

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

Nice to have

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