Referral Authorization Specialist

Memorial Medical Center Las Cruces; Las Cruces (NM); On-site; USD 37,000 - 52,000; Full time

Benefits offered by this job

Comprehensive benefits

Financial protection & PTO

Tuition assistance & career growth

Employee well-being programs

Professional development

Job summary

Memorial Medical Center Las Cruces is seeking a Referral Authorization Specialist to ensure timely care by processing referrals, completing pre-authorizations, and communicating with patients and providers. You will document interactions in the EMR and update referral records as changes occur.

The role requires a high school diploma or equivalent, with two years of college preferred, and the ability to work under pressure in a fast-paced clinical setting.

Qualifications

• High school diploma or equivalent is required.
• Two years of college preferred.

Responsibilities

• Process referrals completely, accurately and promptly; verify required care and notify providers if referrals aren’t followed.
• Complete pre-authorizations for diagnostic testing, therapy, procedures and specialty care within three days.
• Notify patients when referrals are approved and providers when referrals are denied or more info is needed.
• Document all communication with patients, nurses and providers in the clinic EMR.
• Update referral records in the EMR after each communication.
• Explain plan policies and procedures to employees, physicians and patients when changes occur.
• Identify and help resolve patient barriers to specialty care and coordinate appointments.
• Track high-priority referrals to ensure follow-up for high-risk patients.
• Assist with patient assessments and treatments under physician or nurse supervision.
• Perform administrative duties including filing, reception, scheduling, data entry and registration.
• Perform other duties as assigned.

Skills

Critical thinking

Decisive judgment

Work with minimal supervision

Ability to work under stress

Education

High school diploma or equivalent

Two years of college preferred

Tools

EMR system

Job description

Your Experience Matters

Memorial Medical Center is part of Lifepoint Health, a diversified healthcare delivery network with facilities coast to coast. We are driven by a profound commitment to prioritize your well-being so you can provide exceptional care to others. As a Referral Authorization Specialist, joining our team, you're embracing a vital mission dedicated to

Your Experience Matters

Memorial Medical Center is part of Lifepoint Health, a diversified healthcare delivery network with facilities coast to coast. We are driven by a profound commitment to prioritize your well-being so you can provide exceptional care to others. As a Referral Authorization Specialist, joining our team, you're embracing a vital mission dedicated to making communities healthier. Join us on this meaningful journey where your skills, compassion and dedication will make a remarkable difference in the lives of those we serve.

How You'll Contribute

A Referral Authorization Specialist who excels in this role:

• Ensures patients receive the care they need in a timely manner by processing referrals completely, accurately, and promptly; verifying that patients receive the required care; and notifying providers when patients do not follow through with referrals.
• Completes pre-authorizations for diagnostic testing, therapy, surgical procedures, and specialty care appointments according to insurance requirements within three days of issuance.
• Notifies patients when referrals are approved and notifies providers when referrals are denied or when a second opinion or additional information is required.
• Documents all communication with patients, nurses, and providers in the clinic EMR.
• Updates referral records in the EMR following each communication with patients, insurance providers, nurses, or providers.
• Maintains up-to-date knowledge of health care plans and interprets and communicates plan policies and procedures to employees, physicians, and patients when changes occur.
• Identifies and attempts to resolve patient barriers to specialty care, including assisting with appointment scheduling and coordinating with specialist offices.
• Assists with tracking high-priority referrals to ensure patients in high-risk categories receive necessary follow-up care.
• Assists with patient assessments and treatments under the supervision of a physician or nurse.
• Performs administrative and clerical duties as assigned, including filing, reception, scheduling, data entry, and patient registration.
• Performs other duties as assigned.

Education

What we're looking for

• High school diploma or equivalent is required.
• Two years of college preferred.

Skills & Experience

• Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision.
• Must be able to work in a stressful environment and take appropriate action.

Schedule: Full-time

Why join us

We Believe That Investing In Our Employees Is The First Step To Providing Excellent Patient Care. In Addition To Your Base Compensation, This Position Also Offers

• Comprehensive Benefits:Multiple levels of medical, dental and vision coverage for full-time andpart-time employees.
• Financial Protection & PTO:Life, accident, critical illness, hospital indemnity insurance, short- and long-term disability, paid family leave and paid time off.
• Financial & Career Growth:Higher education and certification tuition assistance, loan assistance and 401(k) retirement package and company match.
• Employee Well-being:Mental, physical, and financial wellness programs (free gym memberships, virtual care appointments, mental health services and discount programs).
• Professional Development:Ongoing learning and career advancement opportunities.

More About Memorial Medical Center

Memorial Medical Center is a 199-bed acute medical/surgical teaching hospital located in Las Cruces, NM, and is part of Lifepoint Health, a diversified healthcare delivery network committed to making communities healthier with acute care, rehabilitation, and behavioral health facilities from coast to coast. From your first day to your next career milestone-your experience matters.

EEOC Statement

Memorial Medical Center is an Equal Opportunity Employer. Memorial Medical Center is committed to Equal Employment Opportunity for all applicants and employees and complies with all applicable laws prohibiting discrimination and harassment in employment.

Lifepoint Health is a leader in community-based care and driven by a mission of Making Communities Healthier. Our diversified healthcare delivery network spans 29 states and includes 63 community hospital campuses, 32 rehabilitation and behavioral health hospitals, and more than 170 additional sites of care across the healthcare continuum, such as acute rehabilitation units, outpatient centers and post-acute care facilities. We believe that success is achieved through talented people. We want to create places where employees want to work, with opportunities to pursue meaningful and satisfying careers that truly make a difference in communities across the country.