Authorization/Referral Specialist

Job Description

Job Description

JOB SUMMARY:

The Authorization/Referral specialist works in the Authorization Department within the Centralized Business Office, as a liaison between the physician and the patient. The position interfaces with physicians, patients, and administrative personnel and answers phone calls, responds to fax and email communication and routes messages accordingly. The focus of the position is to obtain prior authorizations for medications and/or procedures.

 

JOB RESPONSIBILITES:

• Obtains authorizations for ancillary tests and medical procedures.

• Responsible for coordinating and processing of all patient referrals including specialty and ancillary services.

• Utilizes a high degree of accuracy in obtaining and verifying that registration, demographic and insurance information is correct and up to date.

• Acts as liaison between the MSO and other healthcare providers while exhibiting a high level of customer service skills.

• Performs eligibility checks on members as necessary by telephone or electronically.

• Follows procedures for proper authorization and processing of all referral services.

• Supports physicians and patients in synchronizing appointments, authorizations and tests taking place in different practices.

• Communicates with patient and practice to ensure follow through with referrals.

• Ensures strict confidentiality of all health records, member information and follows HIPAA guidelines.

• Completes all administrative functions related with referral activities in an efficient manner.

• Enters all referral hospital, outpatient and other patient specialty health service authorizations into the EMR and practice management system.

• Responsible for monitoring all referral reports not received and follow up in a timely manner.

• Performs duties in honest and ethical manner.

• Perform other duties as assigned.