Authorization and Referral Specialist
Middleton Family Medicine is looking for an experienced, enthusiastic Authorization/Referral Specialist for our busy primary care office. The Authorization/Referral Specialist will work together with other members of our Authorization and Referral Team to perform all referral and authorization tasks for the practice. Duties will include referral processing, insurance authorizations, patient registration, verification of benefits, patient appointment scheduling, communication with referral sources and other tasks as assigned.
Primary Duties and Responsibilities-
Responsible for the tracking, coordination and communication of patient referrals and prior authorizations to ensure timely processing of advanced diagnostic imaging authorizations and referrals to external providers
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Ability to navigate web-based portals and/or phone to initiate, update, and complete requests for prior authorizations or referrals
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Verifies complete and accurate patient registration, including demographics and insurance eligibility, with subsequent notification to designated staff of eligibility issues
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Assists patients in problem solving potential health insurance carrier issues
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Contacts insurance companies to ensure verification of benefits and prior authorization or referral approval requirements are met
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Communicates with team members or requesting provider to clarify request for an authorization or referral, such as CPT codes, ICD10, requested timeframes or other missing clinical information
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Schedules appointments for patients when appropriate authorization or referral is obtained and contacts patients with appointment information
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Contributes to team efforts to improve workflow and efficiency
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Meets established quality expectations e.g. confidentiality, accuracy, customer service and professionalism
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Responds to all patient inquiries related to authorizations and referrals
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Performs all other duties as assigned
Minimum Requirements-
High School diploma or equivalent; Bachelor’s degree preferred.
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A minimum of 1 year of experience with insurance authorizations and/or referrals, or in a related healthcare administrative position
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Knowledge of medical terminology
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Solid understanding of health insurance plans, authorization and referral functions, and electronic medical records
Qualifications:
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Solid understanding of HIPAA, health insurance plans and electronic medical records.
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Excellent customer service, multi-tasking, and time management skills
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Ability to achieve team goals while demonstrating organizational values and utilizing resources responsibly
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Proficient computer skills; Athena experience a plus.
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Adept in written and verbal communication, as well as interpersonal communication skills
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Efficient, organized problem solver, able to manage multiple priorities
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Able to take on and follow through with delegated tasks, working both independently and as part of a team
Pay: $21-24/hr
Work Enviornment and Physical Demands:
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Work is performed in person
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Physical demands include sitting for extended periods, typing, phone communication, face-to-face interaction
About Middleton Family Medicine
Our mission at Middleton Family Medicine is to Make Lives Meaningfully Better. To do this, we are continuously expanding our practice and its offerings to provide quality, comprehensive, and compassionate care to patients on the North Shore and beyond. We are committed to hiring people infused with passion and motivated to succeed in an environment that is driven by a collaborative, patient-centric culture. We pride ourselves on our three differentiators that allow us to do what’s best for our patients: offering service 365 days a year, drive-thru healthcare, and on-site specialty teams and ancillary services. Come join us as we continue to grow by investing in our people, programs, and technology to deliver legendary customer service to our patients and to further our reputation as the provider, practice, and employer of choice!
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