Authorization Rep

Job Summary:
100% Remote

Processes referral requests for patients to achieve timely and accurate determinations. Works within scope of practice to complete or forward requests as appropriate to Managed Care physicians and/or nurses as per the Utilization Management (UM) protocols. Maintains required turnaround times for referral completion. Assists providers and patients with referral status questions. Participates in development and implementation of improvements to the referral process and workflows.
These Principal Accountabilities, Requirements and Qualifications are not exhaustive, but are merely the most descriptive of the current job. Management reserves the right to revise the job description or require that other tasks be performed when the circumstances of the job change (for example, emergencies, staff changes, workload, or technical development).

JOB ACCOUNTABILITIES:
Processes referrals per standard work and refer others to nurses and/or MDs as necessary.
Maintains accuracy with attention to detail in each referral.
Monitors daily pending referrals to ensure timeliness standards are met and customer service is maximized.
Reports anticipated problems to Supervisor and/or other stakeholders.
Documents updated status in referrals per standard work.
Provides necessary medical information to obtain final determinations when required.
Processes referrals per health plan contracts and requirements.
Documents determinations in referral as per standard work.

EDUCATION: HS Diploma or equivalent education/experience

SKILLS AND KNOWLEDGE: Medical terminology, Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS)/International Classification of Diseases (ICD)-9 coding knowledge. Competency in using MS Office Excel and Word, other Managed Care programs. Ability to identify, understand and solve problems related to claims and referrals. Communication skills, including understanding of medical concepts, ability to organize thoughts, and communicate issues concisely and effectively. Proven ability to quickly adjust to changing projects and priorities and to multi-task. Organizational skills.