Job Title

Referral Authorization Specialist General Job Summary: The Referral Authorization Specialist will be responsible for managing referrals from the practice to other facilities or service providers and incoming action referrals from other service providers. (This is a full time position that will support the TPC at SouthPark, Monday to Friday 8 am to 5 pm) Primary Job Responsibilities: * Complete all referrals for the clinics and ensure they are processed effectively, making sure they are sent to the correct department. * Responsible for prioritizing Stat Referral Authorizations. * Follow up on sent referrals. * Review patient benefits and eligibility to communicate with clinician and clinical staff pertaining to authorization. * Keep the system up to date with any changes in information. * Manage referral status to ensure clinics have all updated and current information. * Completes referrals for patients and coordinates with referring and receiving practices and/or departments. * Obtains and maintain prior authorizations for diagnostic and ancillary testing. * Handle sensitive information in a confidential manner. * All other duties as assigned. Clinic Support responsibilities include: * Compiles patients' health information including patient symptoms and medical history, exam results, X-ray reports, lab tests, diagnoses, and treatment plans. * Ensures all related reports, labs and demographics are sent to the outside facility prior to their appointment. * Reviews to ensure all forms are completed, properly identified, and signed and that all necessary information in the EHR. * Communicates as needed with physicians and other health care professionals to clarify diagnoses or obtain additional information. * Obtains lab/X-ray reports, hospital notes, referral information, etc.; * Verifies insurance coverage and patient demographics; * Updates charts to ensure that information is complete and filed appropriately. * Ensures timely delivery of outside mail and communication to the physician Requirements: Education, Experience and Certifications: * High School Diploma or GED required. * Minimum 2 years' experience in a health coordination role. * Demonstrated understanding of industry guidelines and best practices. * Thorough understanding of insurance coverage and Medical Necessity policies. * Customer service experience required. * Knowledge of medical records software preferred. * Completion of Hepatitis B Vaccine and Flu Vaccine Form will be required. Candidate may decline vaccination through declination form or may provide record of vaccination from previous employer. * Completion of TB test will be required. Physical Requirements: * Work consistently requires walking, standing, sitting, lifting, reaching, stooping, bending, pushing, and pulling. * Must be able to lift and support weight of 35 pounds * Ability to concentrate on details. * Use of computer for long periods of time.