Authorization and Referral Specialist

VALLEY MEDICAL CENTER

JOB DESCRIPTION

The position description is a guide to the critical duties and essential functions of the job, not an all-inclusive list of responsibilities, qualifications, physical demands, and work environment conditions. Position descriptions are reviewed and revised to meet the changing needs of the organization.

TITLE: Authorization and Referral Specialist

JOB OVERVIEW: The Authorization and Referral Specialist is responsible for supporting the Lifestyle Medicine and Outpatient Rehabilitation service lines by providing treatment authorization, insurance verification, benefit summaries, scheduling, and referral management for all clinical services. Works closely with Patient Financial Services, Admitting Registrars, Providers, Insurance Companies and Patients to ensure a seamless coordination of services.

DEPARTMENT: Lifestyle Medicine and Outpatient Rehabilitation

WORK HOURS: Typically, Monday - Friday, 8:00 am to 5:00 pm or as needed to meet department needs.

REPORTS TO: Lifestyle Medicine/Outpatient Rehabilitation Supervisor, Manager or Director

PREREQUISITES:

High School Graduate or equivalent (G.E.D.) required.

Minimum three (3) years of experience in related medical and/or insurance industry required.

Knowledge of medical terminology and abbreviations required.

Basic skills in keyboarding and using a personal computer in Windows and Microsoft applications required.

Prior experience in using practice management and electronic medical record systems required. Epic experience preferred.

QUALIFICATIONS:

Demonstrated knowledge of clinical ICD-10, CPT, and HCPCS.

Professional written and verbal communication skills through all mediums.

Ability to problem solve, exhibiting independent decision-making skills.

Demonstrated ability to function independently and manage time.

Demonstrated ability to access, analyze and apply concepts associated with protocol, policy, and guidelines.

Excellent analytical, critical thinking and attention to detail skills.

Ability to recognize and understand clinical documentation pertinent for obtaining prior authorizations.

Demonstrated ability to successfully utilize varying computer tools and software packages:

Utilize multiple monitors in facilitation of workflow management.

Healthcare websites/Provider portals.

Business practice management system.

UNIQUE PHYSICAL/MENTAL DEMANDS, ENVIRONMENT AND WORKING CONDITIONS: Requires legible writing and computer/keyboard skills. Excellent telephone skills are essential. Regular and punctual attendance is a condition of employment. Requires the ability to maintain self-composure and a positive attitude under stress. Requires flexible scheduling and extended hours as needed. Requires problem solving and effective resolution of conflicts. Requires the ability to organize and prioritize work, handling multiple demands simultaneously. Comfortable with continual change and can assimilate new information and use it as needed in daily operations.

PERFORMANCE RESPONSIBILITIES:

Generic Job Functions: See Generic Job Description for Administrative Partner

Essential Responsibilities and Competencies:

Effectively plan, direct, and manage high volume of treatments requiring referral management, scheduling, and prior authorization.

Work as part of an integrated team comprised of Patient Access, Patient Financial Services, providers and admitting registrars.

Collaborate with department leadership, clinical providers, and department staff to ensure safe, efficient, professional, and patient-centered care is provided.

Apply clear understanding of the clinic structure, standards, procedures, and guidelines to ensure consistent and quality delivery of services.

Maintains department specific records as assigned, update and verifies patient data in EMR.

Referral Management and Scheduling

Effectively organize and manage various referral work qu