Healthcare Referral & Authorization Specialist

Frederick Health Hospital, Inc.; Frederick (MD); Vor Ort; USD 24.000 - 31.000; Vollzeit

Zusammenfassung

Frederick Health Hospital, Inc. is seeking an on-site Referral Authorization Specialist to join our Patient Access and HIM team.

The role handles insurance referrals, authorizations, eligibility checks, and price estimations for ambulatory services, ensuring adherence to the No Surprise Act. You will verify demographics and financial information, deliver premier customer service to internal and external customers, and collaborate with clinical staff to escalate as needed.

Qualifikationen

• High school diploma or GED; some college coursework preferred in Business/Health Sciences.
• 2+ years healthcare revenue cycle billing/collections.
• 1+ year experience in obtaining authorization and pre-determination.
• Knowledge of CPT and ICD-10 codes.
• Understanding of Medicare/Medicaid, HMO and PPO plans.

Aufgaben

• Complete pre-determination and authorization prior to services.
• Know registration and scheduling for on-site and outpatient services.
• Obtain referrals and physician approvals as required by insurers.
• Verify patient demographics and financial information for all insurances and self-pay.
• Calculate price estimations per payer fee schedule prior to services.

Kenntnisse

Attention to detail

Insurance knowledge

Time management

Clinical knowledge

HIPAA compliance

Ausbildung

High school diploma or GED

Some college coursework preferred

Tools

Microsoft Word

Microsoft Outlook

Microsoft Excel

NextGen

Meditech

Meditech Expanse

Jobbeschreibung

Frederick Health Hospital, Inc. is seeking an on-site Referral Authorization Specialist to join our Patient Access and HIM team.

The role handles insurance referrals, authorizations, eligibility checks, and price estimations for ambulatory services, ensuring adherence to the No Surprise Act. You will verify demographics and financial information, deliver premier customer service to internal and external customers, and collaborate with clinical staff to escalate as needed.