Preauthorization and Referral Assistant

Beloit Health System; 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. The role focuses on obtaining prior authorizations and referrals for procedures, admissions, tests, and medications.

The candidate will respond to inquiries from providers, staff, patients, payers, and employers, verify information in the billing/medical records system, and assist with payer communications to ensure timely reimbursements.

Qualifications

• Requires high school diploma or equivalent; initiative and good judgment.
• Excellent organizational and interpersonal skills for interaction with providers, patients, and payers.
• Strong verbal communication and written communication abilities.
• Proficient computer skills; MS Word and Excel preferred.

Responsibilities

• Obtain prior authorizations and referrals for procedures, admissions, tests, and medications.
• Promptly respond to inquiries from providers, staff, patients, payers, and employers via phone, mail, or in person.
• Verify medical and insurance information using the billing/medical records system and assist with approvals.
• Contact payers and patients to complete preauthorization requirements and relay updates to providers.
• Review daily hospital schedules to ensure preauthorizations are completed and notify providers as needed.
• Document relevant details in the Practice Management System.
• Use work queues to manage claims at various transmission stages and ensure timely processing.
• Maintain knowledge of payer rules and use payer websites to complete authorizations and referrals.
• Interact positively with patients, providers, coworkers, and managers.

Skills

Organizational skills

Verbal communication

Interpersonal skills

Computer skills

Education

High School diploma or equivalent

Tools

MS Word

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

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.

Apply today to join our team!

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