Referral Authorization Specialist

Tryon Medical Partners; Charlotte (NC); On-site; USD 42,000 - 54,000; Full time

Job summary

Tryon Medical Partners is seeking a Referral Authorization Specialist to manage referrals within the practice and coordinating with external facilities. The role is full-time, supporting the TPC at SouthPark, Monday to Friday 8 am to 5 pm.

Responsibilities include processing referrals, prioritizing urgent authorizations, verifying benefits, and maintaining accurate patient information in the EHR. Position requires strong customer service and insurance knowledge.

Qualifications

• High School Diploma or GED required.
• Minimum 2 years’ experience in a health coordination role.
• Demonstrated understanding of industry guidelines and best practices.
• Thorough understanding of insurance coverage and Medical Necessity policies.
• Customer service experience required.
• Knowledge of medical records software preferred.
• Completion of Hepatitis B Vaccine and Flu Vaccine Form will be required; TB test will be required.

Responsibilities

• Complete all referrals for the clinics and ensure they are processed effectively, making sure they are sent to the correct department.
• Prioritize Stat Referral Authorizations.
• Follow up on sent referrals and review patient benefits and eligibility to communicate with clinician and staff pertaining to authorization.
• Keep the system up to date with any changes in information.
• Manage referral status to ensure clinics have updated and current information.
• Completes referrals for patients and coordinates with referring and receiving practices and/or departments.
• Obtain and maintain prior authorizations for diagnostic and ancillary testing.
• Handle sensitive information in a confidential manner.
• All other duties as assigned.
• Clinic support: compile patients’ health information including symptoms, history, exam results, labs, diagnoses, and treatment plans.
• Ensure related reports, labs and demographics are sent to outside facility before appointment.
• Review forms for completeness and proper identification.

Skills

Customer service

Insurance coverage understanding

Attention to detail

Education

High School Diploma or GED

Job description

General Job Summary: The Referral Authorization Specialist will be responsible for managing referrals from the practice to other facilities or service providers and incoming action referrals from other service providers.

(This is a full time position that will support the TPC at SouthPark, Monday to Friday 8 am to 5 pm) Primary Job Responsibilities:

• Complete all referrals for the clinics and ensure they are processed effectively, making sure they are sent to the correct department
• Responsible for prioritizing Stat Referral Authorizations
• Follow up on sent referralsReview patient benefits and eligibility to communicate with clinician and clinical staff pertaining to authorization.
• Keep the system up to date with any changes in information.
• Manage referral status to ensure clinics have all updated and current information
• Completes referrals for patients and coordinates with referring and receiving practices and/or departments
• Obtains and maintain prior authorizations for diagnostic and ancillary testing
• Handle sensitive information in a confidential manner
• All other duties as assigned

Clinic Support responsibilities include:

• Compiles patients’ health information including patient symptoms and medical history, exam results, X-ray reports, lab tests, diagnoses, and treatment plans
• Ensures all related reports, labs and demographics are sent to the outside facility prior to their appointment.
• Reviews to ensure all forms are completed, properly identified, and signed and that all necessary information in the EHR
• Communicates as needed with physicians and other health care professionals to clarify diagnoses or obtain additional information
• Obtains lab/X-ray reports, hospital notes, referral information, etc.;
• Verifies insurance coverage and patient demographics;
• Updates charts to ensure that information is complete and filed appropriately
• Ensures timely delivery of outside mail and communication to the physician

Requirements: Education, Experience and Certifications:

• High School Diploma or GED required
• Minimum 2 years’ experience in a health coordination role
• Demonstrated understanding of industry guidelines and best practices
• Thorough understanding of insurance coverage and Medical Necessity policies.
• Customer service experience required
• Knowledge of medical records software preferred
• Completion of Hepatitis B Vaccine and Flu Vaccine Form will be required. Candidate may decline vaccination through declination form or may provide record of vaccination from previous employer
• Completion of TB test will be required

Physical Requirements:

• Work consistently requires walking, standing, sitting, lifting, reaching, stooping, bending, pushing, and pulling
• Must be able to lift and support weight of 35 pounds
• Ability to concentrate on details
• Use of computer for long periods of time