Referral/Prior Authorization Specialist

ChangePoint Integrated Health Centers; Show Low, Northern (AZ, KY); Hybrid; USD 40,000 - 56,000; Full time

Job summary

ChangePoint Integrated Health Centers is seeking a Referral and Prior Authorization Specialist to support providers and staff by coordinating patient referrals and medication prior authorizations for medical and psychiatric services.

In this non-exempt, full-time role, you will handle clerical tasks, ensure timely authorization requests, and maintain accurate patient records, while delivering courteous service to patients and collaborating with the Office Manager.

Qualifications

• Requires High School Diploma or GED.
• Requires valid Arizona Driver's License.
• Two years' data entry experience preferred.
• Fluent in English, both spoken and written.

Responsibilities

• Coordinate patient referrals and medication prior authorizations for medical and psychiatric services.
• Obtain authorizations from various insurance plans according to their requirements.
• Communicate status of referrals to patients.
• Track and follow up to ensure patients see referred providers and records are received.
• Obtain medication prior authorizations for medical and psychiatric services.
• Answer telephones daily and provide backup for clerical staff.

Skills

English fluency

Literate

Prioritize workload

Analytical skills

Typing accuracy

Customer service

Phone courtesy

Education

High School Diploma / GED

Job description

TITLE: REFERRAL and PRIOR AUTHORIZATION SPECIALIST

STATUS: NON-EXEMPT

LINES OF AUTHORITY: Thisposition is supervised by the Show Low Medical Office Manager.

POSITION SUMMARY: The Referral/Prior Authorization Specialist works with the providers and staff tocoordinate patient referrals and medication prior authorizations for medicaland psychiatric services provided at ChangePoint Integrated Health. Thisposition also provides a variety of clerical and general office support dutiesto facilitate operations of the department and care of patients.

PRINCIPLEDUTIES/RESPONSIBILITIES:

• 1. Adhere to personnel policyand comply with agency requirements for ethical and professionalbehavior.
• 3. Obtains authorizationsfrom various insurance companies according to their plan requirements.
• 4. Communicates status ofreferrals to patient.
• 5. Tracking and following up to close theloop making sure patients have seen referred provider and records are received.
• 6. Obtains medication prior authorizations for both psychiatricand medical services provided.
• 7. Communicates status ofprior authorization to patient.
• 8. Scanning and indexingdocuments into patient charts.
• 9. Answer telephones on adaily basis.
• 10. Provides back up forclerical staff as needed.
• 11. Must participate inmeetings as required.
• 12. This positionrequires positive and active support of the company, thecustomer and the co-worker.
• 13. Performs other dutiesas assigned by the Office Manager.

PRIMARY CONTACTS:

Frequent interaction withcustomers and administrative personnel.

POSITION REQUISITES:

Qualifications and Experience

Required:

• High School Diploma/GED.
• Valid Arizona Driver's License.
• Comply with a Drug FreeWorkplace.
• Two Years' Experience in DataEntry - preferred.

Skills and Abilities

Required:

• Fluent in English both verballyand in writing.
• Literate.
• Able to prioritize own workload.
• Able to effectively employanalytical and problem-solving skills.
• Able to type accurately;perform numeric calculations; computer skills.
• Phone courtesy and customerservice skills.

Preferred:

• Effective time managementskills.
• Able to work forty (40) hoursper week.

WORKING CONDITIONS:

Physical Requirements

Sitting for extended periods oftime at a desk/computer; less frequently, walking, lifting and reaching.

Visual capacity necessary to fulfilldocumentation, responsibilities of job.

Able to hear ordinaryconversation and phone communications.

Equipment Operation

Able to correctly use officeequipment (e.g.: calculator, copier, PC/word processor, fax) and trouble shootcommon office equipment problems.

Able to employ multi-linetelephone system.

Environmental Conditions

Air conditioned and/or heatedoffice setting.

Accommodation(s)

Will accommodate as appropriateand reasonable.

CONFIDENTIALITY LEVEL:

I understand that State andFederal Laws strictly prohibit unauthorized access, use, modification,disclosure, or destruction of confidential, sensitive or protected healthinformation. Penalties for violation may include ChangePoint disciplinaryaction, including termination of employment, and/or criminal or civil action.