Referral/Prior Authorization Specialist - Monadnock Gastroenterology Associates - Per Diem

Referral & Prior Authorization Specialist

The referral & prior authorization specialist is responsible for ensuring the timeliness and accurate use of referrals by; monitoring appropriateness, medical necessity, and provides necessary information to obtain authorization.

• Performs telephonic support for online authorization of routine services
• Provides direct support to Primary Care practices and specialty care providers regarding utilization, authorization, and referral activities
• Becomes proficient in the use of ICD-9/ICD-10 and CPT codes
• Contacts providers with authorization, denial, and appeals process information
• Assists in educating and acts as a resource to primary care practices and specialty care providers in regards to prior authorization needs.

• Verifies eligibility of members and participating status of providers
• Determines member benefit coverage
• Performs other duties as required
• Receive, track and obtain insurance authorization from in-network and out-of-network insurance carriers for New Patient and Follow-Up visits with our medical providers.
• Process physician referral orders (EMG, CT, MRI, etc.) using eCW (EMR system). This includes obtaining any insurance authorization needed.
• Coordinate referrals for insurance plans that require authorization (work comp, etc). This includes obtaining any insurance authorization needed.
• Accurately enter notes into eCW regarding letters or correspondence from insurance companies regarding insurance authorization or other notifications. These documents should also be scanned into the appropriate patients chart in eCW.
• Calling incoming referrals and scheduling office visits based on the referral
• Demonstrate and apply knowledge of medical terminology, high proficiency of general medical office procedures including HIPAA regulations.

This is a per diem position.

Per diem employees enjoy:

• Free membership to local gym
• Positive work environment with a supportive team and opportunities for growth
• Retirement savings plan

Join a culture of Compassion, Collaboration, Honesty, and Respect! At Monadnock Community Hospital, our employees are the heart and soul of MCH.

Balance meaningful work with a great life. Here in the Monadnock Region, you can enjoy a standard of living that is hard to match anywhere. Let's start with our mountain for which we are named.

• New England community spirit
• Family-friendly
• Arts and culture
• All-season outdoor recreation
• Just 1.5 hours to Boston

Our small hospital is committed to diversity, inclusion, and equal opportunity employment. We welcome applications from individuals of all backgrounds and abilities. We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, disability status, veteran status, or any other characteristic protected by law.

Qualifications

Behaviors:

• Required : Detail Oriented: Capable of carrying out a given task with all details necessary to get the task done well
• Required : Team Player: Works well as a member of a group

Education:

• Required : High School or better.

Experience:

• Required : Exceptional customer service Excellent computer, multi-tasking and phone skills. At least one year of pre-cert experience, including navigating websites for online benefit reviews.
• Preferred : Prior experience with referrals, calling patients and scheduling appointments from referrals