Referral and Prior Authorization Specialist

Medical Referral And Prior Authorization Specialist

Position - Medical Referral and Prior Authorization Specialist - FLSA Status - Hourly Non-Exempt

Reports to - Documents Manager - Shift - 8 hour shifts (varies)

Wage: $15.00- $16.00 per hour

Education:

• High School Diploma or GED required
• Medical Terminology Knowledge required
• Medical Experience preferred

Responsibilities:

• Process referral requests made by providers.
• Gather medication information: quantity, diagnosis, dosages, directions
• Gather patients current insurance information
• Ensure accuracy of forms and clinical questions per insurance company
• Utilize the covermymeds system for medication prior authorizations and keeping the requests cleaned up.
• Enter requests into the DASH system and compile referrals and records to be sent to the specialist office ensuring that the provider we send a patient to accepts the insurance the patient has..
• Communicate with the patientsthe status of any referrals or prior authorizations sent on a patient's behalf.
• Obtain authorizations as required for patients to see specialists or procedures that they ordered as necessary.
• Work on lab rebills as needed.
• Transmit information or documents to customers, using a computer, mail, or facsimile machine.
• Analyze data to determine answers to questions from patients.

Abilities:

• High-level of multi-tasking
• Time management skills
• Medical Terminology
• Team player
• Follow step-by-step procedures
• Personable

Physical Requirements:

• Requires full range of body motion including handling and lifting of patients, manual and finger dexterity, and hand-eye coordination.
• Requires standing and walking for extensive periods of time
• Occasionally lifts and carries items weighing up to fifty (50) pounds
• Requires corrected vision, hearing, and speech within normal ranges
• Requires working under stressful conditions and sometimes irregular hours
• Potential contact with bloodborne pathogens, bodily secretions, etc.

Background Screening Requirements:

• You must pass a level 2 background screening PRIOR to joining Suntree Internal Medicine. If you have have one done and do not have one on file, after 90 days of employment Suntree Internal Medicine will reimburse you for this up to $85.00. Please provide your receipt to HR on your first day.

About Suntree Internal Medicine:

We are a large private internal medicine practice located in Melbourne, Florida. We are an equal opportunity employer and we believe that education and training are a key part of success. Our values are to bring Sincerity, Inspiration, and Mastery into the workplace. We offer benefits, paid time off, 401K and holidays after the 90-day probation period review.