Referral & Authorization Specialist
This position is responsible for coordinating referral orders for a continuation of treatment, such as specialty services and diagnostic testing for clinic provider practice. This position provides all pertinent clinical information needed for the payor authorization and the facility or specialist prior to the services being rendered. The position acts as a liaison between the patient and the specialty area by navigating the appointment process and ensuring that proper authorization(s) are obtained for the appointment, to provide a seamless experience for our patients. This position is responsible for tracking and managing all referrals with the intention and outcome to close any patient care gaps, along with providing documentation to promote team awareness.
Essential Job Duties:
- Acts as a liaison between patients, providers, departments and staff members for patient’s referral and follow up needs. Provides prompt and professional service for the patients by assisting in educating patient/family and assisting patients with external resources when needed.
- Collaborates with providers and departments of assigned specialty(ies) to determine all CPT Codes provider will need authorized before appointment.
- Provides all pertinent clinical information needed for the payer authorization for the facility or specialist prior to the services being rendered by verifying coverage, obtaining authorization and communicating with receiving facilities for incoming referrals as well as pre-planned in office procedures.
- Reviews upcoming provider schedules to ensure all appointments have appropriate referral and authorizations required for anticipated visits and procedures.
- Applies knowledge of medical terminology, ICD-10 and CPT Codes and maintains up to date knowledge of insurance environment. Utilizes internal and external resources to seek knowledge about regulations regarding various payor sources.
- Collaborates with outside referral sources and other community resources. Maintains an updated list of community resources and networks with colleagues to develop additional referral sources.
Other Job Duties:
- Communicate effectively with all co-workers in a courteous and professional manner
- Attend organizational and department meetings when indicated
- Participate in team discussions and planning
- Follow all hospital policies and procedures
- Perform any other duties as assigned by the Clinic Admitting Supervisor or Patient Access Manager
- High school diploma or equivalent
- Computer literate with proficiency in Microsoft Word & Excel
- Excellent communication skills,
- Excellent customer service skills
- Strong organization skills and ability to multitask
- Knowledge of third-party payers
- Previous experience in patient access
- Bilingual/Spanish preferred
Physical Requirements/Working Conditions:
While performing the duties of this job, the employee may be required to sit for long periods of time. Must be able to work paying close attention to detail with frequent interruptions. Must be able to lift and carry up to 20 lbs. frequently and 50 lbs. occasionally.