Referral & Authorization Coordinator

Job Description

Job Description

We are looking for a energetic, hard-working, dependable, multi-tasking Medical Insurance Authorization specialists who are passionate about helping others and making a difference.

DUTIES AND RESPONSIBILITIES:

• Verifies information provided by referring physicians and verifies insurance coverage.
  • Analyze patient records and insurance policies to determine if procedures, treatments, or medications require prior authorization
  • Ensure patients are eligible for services and that insurance benefits are accurate
  • Interacts with healthcare providers, insurance companies, and patients to obtain and provide information needed for authorization decisions
  • Notify providers of potential coverage options
  • Communicate with patients about the authorization process and any potential delays or financial implications.
  • May suggest formulary/cheaper alternatives for expensive drugs.
  • May investigate any serious drug interactions with the requested drug.

• Completes authorizations and referrals for our medical services, including appointments and procedures.
  • Input new patient information and update information in our system
  • Compile and submit detailed authorization requests to insurance companies, including all necessary documentation
  • Research and resolve any issues or discrepancies related to authorization requests
  • Monitor and follow up on authorization requests to ensure timely processing
  • Investigate insurance denials and resubmit requests or appeal when necessary.
  • Complete billing documentation
• Monitors the schedule for add-on patients, ensuring no conflicts, and we have required prior authorization to move forward with appointment or procedure.
• Remain informed about healthcare industry regulations, trends and insurance policies
• Assist with other clerical tasks as needed and perform other related duties as assigned by management.

QUALIFICATIONS:

• High school diploma or general education degree (GED), or one to three months related experience and/or training, or equivalent combination of education and experience. Associate degree a plus.
• Some experience in medical billing or insurance authorization (strongly preferred).
• Knowledge of medical terminology.
• Basic computer skills.
• Attention to detail.

JOB TYPE / WORK SCHEDULE:

• This is a full-time position, in-office position
• Standard office hours, Monday - Friday 8:00 AM - 4:30 PM
• Bilingual Required

Competitive pay and full benefits package, including 401(k), health, dental, vision, life, and disability insurance.