Preauthorization and Referral Assistant

beloithealthsystem; Beloit (WI); On-site; USD 38,000 - 46,000; Full time

Job summary

Beloit Health System is seeking a Preauthorization & Referral Assistant to join the Insurance & Billing team in Beloit, WI. The role focuses on obtaining prior authorizations and referrals for procedures, admissions, tests and medications.

The position requires strong organizational and communication skills, experience with billing systems, and ability to work with providers, patients and payers. 40-hour weeks, first shift, with a 8:00 a.m. to 4:30 p.m. schedule.

Qualifications

• Knowledge of medical terminology and prior insurance experience.
• Excellent organizational, verbal communication and interpersonal skills.
• Experience with MS Word and Excel is preferred.
• Ability to adhere to policies and maintain confidentiality.

Responsibilities

• Obtain prior authorizations and referrals for procedures, admissions, tests, and medications.
• Respond to inquiries from providers, staff, patients, payers, and employers by phone, mail, or in person.
• Verify medical and insurance information in billing/medical records system.
• Contact payers and patients to satisfy preauthorization and second opinion requirements.
• Document details in the Practice Management System.
• Work queues and ensure timely processing of claims.
• Maintain knowledge of payer rules and use payer websites.
• Interact professionally with patients, providers, coworkers and managers.

Skills

Medical terminology

Insurance experience

MS Word

Excel skills

Verbal communication

Organizational skills

Interpersonal skills

Education

High School diploma

Tools

Practice Management System

Billing/medical record system

Job description

Beloit Health System is looking to add a Preauthorization & Referral Assistant to our Insurance & Billing team!

• Shift: First
• Schedule: 8a – 4:30p
• Hours per week: 40
• Benefits Status: Eligible
• Department: Beloit Clinic Insurance/Billing

The Preauthorization and Referral Assistant will be responsible for obtaining prior authorizations and referrals for procedures, admissions, tests, and medications..

• Promptly responds to inquiries and requests for assistance from providers, staff, patients, payers, and/or employers via telephone, by mail, or in person.
• Obtains and verifies pertinent medical information and insurance information via the billing/medical record system. Assist sprovider with prior authorization/referral of drugs, including contacting Payers, patient, completing forms and keeps provider updated during this process.
• Contacts patient Payer(s) regarding preauthorization and/or second opinion requirements prior to procedures, hospital admissions, and tests to assure reimbursement for charges incurred for these services.
• Reviews daily hospital .schedules to confirm that all required preauthorization have been completed and notifies provider appropriately..
• Documents pertinent details in the Practice Management System.
• Uses work queues to identify and work claims in various states of transmission and ensures they are worked in a timely manner.
• Maintains a working knowledge of Payer rules.
• Utilizes available Payer websites to complete authorizations and referrals. Demonstrates ability to perform functions accurately and efficiently with computer software
• Interacts in a positive, responsible and cooperative manner with patients, Providers, co-workers and managers.

Job Requirements:

• High School graduate or equivalent. Initiative and sound judgment.
• Excellent organizational, verbal communication and interpersonal relation skills to be utilized with providers, patients, public staff and payers.
• Must have knowledge of medical terminology, previous insurance experience, or Medical Assistant experience.
• Excellent computer skills, with MS Word and Excel preferred.
• Must adhere to established regulatory agencies, Beloit Health System, and department policies, rules and regulations.
• Maintain ethical conduct and keep confidential personal, financial and medical information about patients
• Reporting Relationship: Director of Revenue Cycle.