Prior Authorization Representative

Referral And Authorization Representative

SEIU Pay Range: $25.29 to $37.96 Dependent on Experience

The 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 operations
• Knowledge of medical terminology, procedural, and diagnosis coding
• Ability to prioritize duties, perform them efficiently and adjust to and accept the unexpected
• Excellent spelling and grammar
• Excellent telephone manners and etiquette
• Strong analytical, organizational and time management skills
• Knowledge of various insurance plans such as Medicaid, Medicare, Commercial, Worker's Compensation and auto
• Experience using electronic medical record
• Ability to complete assigned projects and meet deadlines
• Knowledge of the cultural and social backgrounds of the variable population groups with the ability to be nice and friendly to our patients

License/Certification: N/A

Education and/or Experience

• One year experience in medical office setting
• Previous experience with authorizations and/or referrals preferred
• Experience using medical terminology, CPT and ICD10 coding preferred
• Experience working with PC based computer operations
• Must be detailed oriented with excellent organizational skills

Physical Demands and Work Environment Conditions / ADA Compliance

Position 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.