Referral & Pre-Auth Specialist

Hollister Incorporated; Town of Florida (NY); On-site; USD 42,000 - 54,000; Full time

Benefits offered by this job

Health Insurance

401k Plan with Company Match

PTO and Paid Holidays

EAP

Employee Discounts

Job summary

ABC Medical is one of the nation’s leading urological supply providers and offers a comprehensive line of medical supplies and services, including Urological, Incontinence, Wound Care, and Ostomy products.

The Referral Specialist verifies, reviews, and determines compliance of documents for local coverage determinations and pre-authorizations; communicates with providers, insurers, and Sales Managers while upholding HIPAA and SLA requirements.

Qualifications

• High School Diploma or equivalent work experience.
• 2+ years of work experience.
• Basic understanding of payor guidelines.
• Analytical skills required, attention to detail, and organized.
• Basic Microsoft skills.
• Ability to work well in a team environment.

Responsibilities

• Verify, obtain, review, and determine that all medical documentation meets local coverage determinations and regulatory requirements for Pre-authorizations.
• Examine documents to verify required compliance, completeness, and accuracy of data.
• Confer with document originator and approvers to resolve discrepancies.
• Contact insurance companies to confirm coverage and eligibility of products.
• Obtain prior authorization and/or referrals.
• Update customer database when obtaining documents and pre-authorizations.
• Update document databases and corresponding files.
• Generate communication to appropriate personnel on new and revised documents including Pre-authorization requests.
• Regularly communicate with Health Care Providers, Commercial and Government Payors, and Sales Managers.
• Achieve defined service level agreements.
• Communicate Payor requirements as they are discovered.
• Adheres to HIPAA guidelines/regulations.

Skills

Analytical skills

Attention to detail

2+ years experience

Payor guidelines

Teamwork

Microsoft Office

Education

High School Diploma or equivalent

Tools

Microsoft Office

Job description

ABC Medical is one of the nation’s leading urological supply providers and offers a comprehensive line of medical supplies and services, including Urological, Incontinence, Wound Care, and Ostomy products.

The Referral Specialist verifies, reviews, and determines compliance of documents for local coverage determinations and pre-authorizations; communicates with providers, insurers, and Sales Managers while upholding HIPAA and SLA requirements.