REFERRAL & AUTHORIZATION SPECIALIST

- Answer and return phone calls promptly to patients, insurance companies, central scheduling, and physicians.
- Manage and process prior authorization requests efficiently to ensure timely patient care.
- Review and interpret medical records, documentation, and provider notes for authorization and scheduling purposes.
- Collaborate with insurance companies to obtain authorization for patient appointments and resolve any discrepancies. Sending documentation to insurance, entering authorization information into EPIC, and forwarding authorization to the appropriate department.
- Maintain accurate and complete medical records in compliance with HIPAA regulations.
- Perform insurance verification to confirm patient eligibility and benefits prior to scheduling or obtaining authorization.
- Maintain physician schedules as well as make adjustments as cancellations occur. Ensure that the physician schedules are filled according to their guidelines.
- Schedule patients into order based on physician preferences and/or work with physician to arrange preferred order. Patients identified as priority should be treated as such.
- Utilize medical terminology effectively when communicating with providers, insurers, and patients.
- Ensure all activities adhere to managed care policies and healthcare regulations.
- Performs other duties as assigned.

EDUCATION/EXPERIENCE
High School diploma and/or equivalent required,
AND
a successful completion of a competency-based Medical Assistant (MA) training program required.
OR
One (1) year experience in clinical (direct patient care) and/or medical (administrative patient support) required.

KNOWLEDGE/SKILLS/ABILITIES
- Knowledge of proper release of information standards.
- Excellent oral communication and interpersonal skills.
- Excellent organization, time management skills and attention to detail.
- Proficiency with basic computer and typing skills.
- Ability to remain calm in stressful/difficult situations while demonstrating sensitivity and compassion in all patient interactions.
- Ability to work independently or as part of a team.
- Ability to maintain confidential information.

WORKING CONDITIONS/PHYSICAL DEMANDS
- Ability to maintain punctual attendance consistent with ADA, FMLA, and other federal, state, and local standards.
- Constant sitting, talking, hearing, near vision, and midrange vision.
- Occasional lifting up to 25 lbs.
- Frequent depth perception, visual accommodation, and color vision.
- Occasional standing, walking, twisting, reaching, feeling, and field of vision.
- Must be able to sit and type for long periods of time.
- Must be able to use the telephone for long periods of time.