Job Details

REFERRALS/ PRIOR AUTHORIZATION: Processing of all referrals and prior authorizations (hereafter referred to as 'referral') to ensure timely handling in order to meet the department's financial, customer service and regulatory standards. Provides education and customer service to providers, staff and patients regarding the department referral process. Provides data entry and clerical support for the referral process for both pre-paid and fee-for-service health plans. Understands each health plan's guidelines, benefits and basic risk models. Understands and follows department's referral processes and procedures. Performs insurance verification and authorization including eligibility checks and complex phone calls to insurance companies to determine patient coverage. Performs ongoing insurance reauthorization as needed. Understands and follows department's referral processes and procedures. Identifies and resolves patient, provider, department and insurance company concerns, requests and ...Revenue, Intake, Specialist, Customer Service, Staff, Processing, Healthcare