What are the responsibilities and job description for the Authorization/Referral Specialist position at Bothwell Regional Health Center?
JOB SUMMARY:
The Centralized Scheduling/Auth Referral Specialist is responsible for obtaining authorization and sending records for referrals for specific providers, maintaining a worklist and spreadsheet, answering incoming calls coming to the auth/ref group. The Centralized Scheduling/Auth Referral Specialist reports directly to the Patient Financial Services Director.
QUALIFICATIONS:
Education:
1. High School Graduate preferred
2. Licensure/Certification:
a. None required.
3. Work Experience:
Minimum 1-year experience providing clinical information to insurance companies required.
Experience in answering phone calls in a medical setting required.
Experience obtaining authorizations and referrals required.
RESPONSIBILITIES/JOB DUTIES:
Reviews each department’s schedule and obtains authorization if required and notates it in Authorization Referral Management software. If any additional information is needed before the test will be notated on account.
Works daily Authorization Referral Management software work list for scheduled appointments for hospital and ancillary services.
Verifies insurance coverage and obtains pre-certification and authorization on inpatient, outpatient, emergency room and recurring accounts.
Answers all calls coming into the authorized referral line.
Document in Meditech system any action taken on all patients’ accounts.
All other duties as assigned.
REQUIRED STAFF COMPETENCIES:
Demonstrates support for organizational and departmental mission.
Supports and demonstrates knowledge of the Strategic Plan and the Hospital Key Values.
Fosters and promotes teamwork within department and the organization as a whole.
Works to resolves conflicts constructively and in a timely manner.
Ability to communicate effectively and simply with every customer and co-worker.
Ability to display a positive, courteous and friendly attitude toward all contacts.
Ability to build good relationships with others based upon a sustained effort of mutual support toward common goals.
Ability to exercise good judgment, reasoning and concentration to detail and to take personal accountability for all actions in carrying out job duties.
Is customer focused and committed to Quality and Process Improvement with a strong desire to provide service excellence.
Possesses and displays a strong knowledge and understanding of the standards of practice for their position including, if and when applicable, commensurate computer skills; population specific and general competencies; organizational skills, time and project management.
Possesses a vigorous and enthusiastic desire to learn and to grow both personally and professionally, and to improve one's skills in order to deliver the best possible care for our customers.
WORKING CONDITIONS:
Normal office conditions
Required to handle highly confidential information
Productivity demanding.
Able to work with interruptions.
Ability to multitask.
The Centralized Scheduling/Auth Referral Specialist is responsible for obtaining authorization and sending records for referrals for specific providers, maintaining a worklist and spreadsheet, answering incoming calls coming to the auth/ref group. The Centralized Scheduling/Auth Referral Specialist reports directly to the Patient Financial Services Director.
QUALIFICATIONS:
Education:
1. High School Graduate preferred
2. Licensure/Certification:
a. None required.
3. Work Experience:
Minimum 1-year experience providing clinical information to insurance companies required.
Experience in answering phone calls in a medical setting required.
Experience obtaining authorizations and referrals required.
RESPONSIBILITIES/JOB DUTIES:
Reviews each department’s schedule and obtains authorization if required and notates it in Authorization Referral Management software. If any additional information is needed before the test will be notated on account.
Works daily Authorization Referral Management software work list for scheduled appointments for hospital and ancillary services.
Verifies insurance coverage and obtains pre-certification and authorization on inpatient, outpatient, emergency room and recurring accounts.
Answers all calls coming into the authorized referral line.
Document in Meditech system any action taken on all patients’ accounts.
All other duties as assigned.
REQUIRED STAFF COMPETENCIES:
Demonstrates support for organizational and departmental mission.
Supports and demonstrates knowledge of the Strategic Plan and the Hospital Key Values.
Fosters and promotes teamwork within department and the organization as a whole.
Works to resolves conflicts constructively and in a timely manner.
Ability to communicate effectively and simply with every customer and co-worker.
Ability to display a positive, courteous and friendly attitude toward all contacts.
Ability to build good relationships with others based upon a sustained effort of mutual support toward common goals.
Ability to exercise good judgment, reasoning and concentration to detail and to take personal accountability for all actions in carrying out job duties.
Is customer focused and committed to Quality and Process Improvement with a strong desire to provide service excellence.
Possesses and displays a strong knowledge and understanding of the standards of practice for their position including, if and when applicable, commensurate computer skills; population specific and general competencies; organizational skills, time and project management.
Possesses a vigorous and enthusiastic desire to learn and to grow both personally and professionally, and to improve one's skills in order to deliver the best possible care for our customers.
WORKING CONDITIONS:
Normal office conditions
Required to handle highly confidential information
Productivity demanding.
Able to work with interruptions.
Ability to multitask.