Prior Authorization and Referral Specialist

NEW MEDICAL HEALTH CARE; Wichita (KS); On-site; USD 38,000 - 48,000; Full time

Job summary

Hutchinson Clinic is seeking a Prior Authorization Specialist to obtain prior authorizations and predeterminations from payers for all services. The role involves collecting patient demographic, insurance, and clinical data to ensure reimbursement requirements are met, and entering information into Allscripts Practice Management for accurate claims submission.

You will serve as a primary resource on prior authorization requirements and educate providers and staff on the process, while adhering

Qualifications

• High School Diploma or GED required.
• Knowledge in medical service coding is preferred.
• Familiarity with medical terminology or willingness to learn.

Responsibilities

• Obtain prior authorizations from payers for inpatient and outpatient services.
• Collect demographic, insurance, and clinical information from patients.
• Enter prior authorization data into Allscripts Practice Management for claims filing.

Skills

Communication skills

EMR familiarity

Education

High School Diploma or GED

Job description

Role:The Prior Authorization Specialist is responsible for obtaining prior authorization and/or predeterminations, from payers for inpatient and outpatient services provided by Hutchinson Clinic providers. The Prior Authorization Specialist collects demographic, insurance, and clinical information from patients to ensure that all reimbursement requirements are met.Essential Functions and Responsibilities:Researches all information needed to complete the referral/precertification process.Understands insurance requirements for prior authorizations. Serves as a primary resource to all clinic staff regarding prior authorization requirements for all services provided.Collects and reviews clinical data, medical terms, diagnosis, medical history, and procedure codes (without the need for interpretation) and follows established procedures for authorizing requestsContact payer to obtain prior authorization. Gather additional clinical and/or coding information, as necessary, in order to obtain prior authorization. Enter prior authorization information into Allscripts Practice Management to ensure accurate and timely claims filing.Verify that all insurance requirements for outpatient and/or inpatient procedures have been met.Advise providers and their clinical staff when issues arise relating to obtaining prior authorization. If necessary, notify Patient Financial Services of uninsured situations.Regularly attends and participates in assigned meetings. Stay informed and research information regarding new procedures and insurance coverage positionsEducate providers and their clinical staff regarding the prior authorization process.Knows and consistently implements the organizations mission and all approved policies, protocols, and procedures.Regularly supports compliance and accreditation efforts as assigned (e.g. OSHA, HIPAA)Consistently demonstrates good use of time and resources.Communicates effectively and professional with patients, staff, and providersPerforms other duties that may be assigned from time to time.Performance Measurements:Performs all Essential Job functions and responsibilities.Maintains a professional and positive attitude, appearance and relationship with patients and staff.Observes all clinic guidelines and polices.Knowledge and Skills:Experience: Up to 6 months in a similar or related healthcare position.Education: High School Diploma or GED equivalent. Knowledge in medical service coding is preferred. Familiarity with medical terminology or willingness to learn.Interpersonal Skills: Ability to deal with customers, courteously, politely, and effectively. Knowledge of EMR system. Must demonstrate consistent professional conduct. Must possess excellent verbal and written communication as well as excellent interpersonal skills with patients, staff, and other health care professionals.Physical Requirements:Ability to use a computer keyboard and mouse 6-8 hours per dayAbility to dial, answer, and talk on the telephone for 6-8 hours per dayVision and hearing to normal rangeWork Environment: Minimal exposure to communicable diseasesThis Job Description is not a complete statement of all duties and responsibilities comprising the position.