Authorization / Referral Specialist

Job Title

No weekends or holidays. Overtime available based on department needs.

Definition/Primary Function

Responsible for selected fiscal aspects of scheduled/registered accounts to prepare account for billing, assuring maximum payment on a timely basis, and maintenance of accurate history files. The position is also responsible for daily review of selected scheduled/registered patients to assure a solid source of reimbursement is in place. The position will obtain all authorizations to avoid insurance denials and assure timely and appropriate third party reimbursement. They will handle inquiries and response of the appeals process. Responsible for all inquiries from patients, families, professional and institutional providers, inter and intra department staff, Government and third party payers, case management companies, patient accounting, clinical department staff, and case managers until the time of billing. Acts as a patient advocate for patients with self-pay liabilities by informing them of hospital collection policy, and referring them to the Advocacy for Access Office.

Position Qualifications (Minimum Qualifications Are Required Unless Stated Otherwise.)

Experience:

• Three years experience in a hospital admitting/billing office setting required.
• Expert knowledge of all major third party payers, including Medicare, Medicaid, and Blue Cross required.
• Three years of experience with the Scheduling and/or Admitting Meditech modules and/or AllScripts scheduling and registration modules.

Education and Training:

• Two years of college (business/health related) or equivalent work experience.

License, Certification & Registration:

• N/A

Other Requirements:

• Strong typing ability (40 wpm) and computer skills (ie. Personal Computer - Windows). Manual dexterity necessary for typing/computer purposes.
• Professional presentation with exceptional Customer Service skills including oral, written and telephone communication required.
• Ability to speak the English language in a clearly understandable manner.
• Proven ability to interact appropriately with hospital staff and physicians, acting as a role model in representing the Medical Center to the community.
• Ability to consistently maintain high level of confidentiality.
• Demonstrated ability to handle stressful situations calmly and rationally, control potentially difficult people/situations, and meet deadlines, even with high volume of interruptions.
• Demonstrated ability to work independently, prioritize duties and manage time with a minimum of supervision.
• Demonstrated high level of professional judgment, problem solving and strong organizational skills.
• Ability to troubleshoot and maintain proper operation of business equipment.
• Proven ability to learn quickly as technology/insurance requirements change.
• Proven ability to be an effective team member.