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; Adheres to approved protocols for working referrals and prior authorizations; Manages department referrals; Acquires insurance authorization; Processes outgoing and incoming referrals; Other duties as assigned

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