Preauthorization and Referral Assistant

Beloit Health System; Beloit (WI); On-site; USD 36,000 - 48,000; Full time

Job summary

Beloit Health System is seeking a Preauthorization & Referral Assistant to join the Insurance & Billing team. This role focuses on obtaining preauthorizations, processing referrals, verifying benefits, and coordinating with providers, insurance companies, and patients to ensure timely access to care.

Responsibilities include tracking authorizations, handling referrals, verifying coverage, communicating with payers, and maintaining accurate EHR records.

Qualifications

• High School graduate or equivalent.
• Knowledge of medical terminology and familiarity with insurance processes.
• Experience in medical office operations or related field.

Responsibilities

• Obtain and track insurance preauthorizations for procedures and services.
• Process referrals accurately and timely.
• Verify patient insurance coverage and authorization requirements.
• Communicate with insurance companies about status and requests.
• Coordinate with providers and staff to gather records.
• Notify patients of status and requirements and ensure access to care.
• Maintain records in EHR and referral systems.
• Monitor expiration dates and obtain renewals as needed.
• Ensure HIPAA compliance and assist with billing issues.

Skills

Organizational skills

Verbal communication

Interpersonal relations

Initiative

Judgement

Medical terminology

Insurance experience

Medical Assistant experience

MS Word

MS Excel

Multitasking

Education

High School diploma

Tools

MS Word

MS Excel

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

We are seeking a detail-oriented and patient-focused Preauthorization and Referral Assistant to join our healthcare team. This role is responsible for obtaining insurance preauthorizations, processing referrals, verifying patient benefits, and coordinating with providers, insurance companies, and patients to ensure timely access to care. The ideal candidate will have strong organizational skills, experience in medical office operations, and a commitment to delivering excellent patient service.

• Obtain and track insurance preauthorizations for procedures, diagnostic studies, medications, and specialty services.
• Process incoming and outgoing referrals accurately and in a timely manner.
• Verify patient insurance coverage, eligibility, benefits, and authorization requirements.
• Communicate with insurance companies regarding authorization status, denials, appeals, and additional documentation requests.
• Coordinate with providers and clinical staff to gather necessary medical records and supporting documentation.
• Notify patients of authorization and referral status, appointment requirements, and any insurance-related issues.
• Maintain accurate records in the electronic health record (EHR) system and referral tracking systems.
• Monitor authorization expiration dates and obtain renewals as needed.
• Ensure compliance with HIPAA and all applicable healthcare regulations.
• Assist with resolving billing and insurance-related issues connected to referrals and authorizations.
• Support front office and administrative functions as assigned.

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.
• Strong attention to detail and organizational skills.
• Excellent verbal and written communication skills.
• Ability to manage multiple priorities in a fast-paced environment.
• Maintain ethical conduct and keep confidential personal, financial and medical information about patients
• Reporting Relationship: Director of Revenue Cycle.