Prior Authorization Representative

Referral And Authorization RepresentativeSEIU Pay Range: $25.29 to $37.96 Dependent on ExperienceThe Referral and Authorization Representative coordinates and facilitates the process of internal and external referrals and authorizations for CMH. This role responds to and processes standard and complex referral and authorization requests. Referral and authorization processing includes verifying eligibility, medical necessity, procedure and diagnosis coding, and patient benefit information. This position is accountable for efficient follow through on all aspects of this process which includes communicating with patients and working any authorization denials and creating appeals. In addition, this role holds expert-level knowledge of the daily workflows and consistently identifies areas of improvement while demonstrating CMH CARES values.Job Requirements: Knowledge of/Skill/Ability to:Knowledge of the medical group or hospital operationsKnowledge of medical terminology, procedural, and diagnosis codingAbility to prioritize duties, perform them efficiently and adjust to and accept the unexpectedExcellent spelling and grammarExcellent telephone manners and etiquetteStrong analytical, organizational and time management skillsKnowledge of various insurance plans such as Medicaid, Medicare, Commercial, Worker's Compensation and autoExperience using electronic medical recordAbility to complete assigned projects and meet deadlinesKnowledge of the cultural and social backgrounds of the variable population groups with the ability to be nice and friendly to our patientsLicense/Certification: N/AEducation and/or ExperienceOne year experience in medical office settingPrevious experience with authorizations and/or referrals preferredExperience using medical terminology, CPT and ICD10 coding preferredExperience working with PC based computer operationsMust be detailed oriented with excellent organizational skillsPhysical Demands and Work Environment Conditions / ADA CompliancePosition involves standing, walking, stooping, and occasional carrying and lifting of lightweight materials (up to 20 pounds). May be required to sit for extended periods of time. Requires visual acuity and depth perception to recognize words and numbers; and hand and finger dexterity and hand/eye coordination to use a computer keyboard and common office equipment.