Referral & Authorization Specialist

Team Impact

Requirements

In this position, you will be a vital member of the cancer treatment program by serving as the point person for managing insurance authorizations/referrals. You will closely support this team by obtaining authorizations from providers and payers while ensuring all reimbursement requirements are met. You will help to improve the overall patient experience by using your customer service skills and insurance expertise to help our patients and their families address any questions/concerns they may have related to insurance coverage and reimbursement requirements. Some highlights about this opportunity include:

• Full time role during the daytime hours only
• On the job training available to ensure career growth and success
• Great opportunity for advancement for those with a background in patient registration, customer service, and insurance processing
• Your work will help to improve the health of our community by supporting vital administrative functions related to cancer and hematology care/treatment
  
  

The Glens Falls Hospital Impact

Mission

Our Mission is to improve the health of people in our region by providing access to exceptional, affordable, and patient-centered care every day and in every setting.

Responsibilities

How You Will Fulfill Your Potential

• Verify patient insurance eligibility & coordination of benefit
• Prepare and compile necessary documentation to secure prior authorization.Collect clinical information regarding service to be rendered as applicable (as well as medical records)
• Interview patients to apprise them of their insurance benefits, contingent on the type of procedure/ level of care with a goal of securing the collection of patient financial obligations / secure payment arrangements
• Contact provider/payer to obtain prior authorization
• Gather additional clinical and / or coding information as necessary in order to obtain prior authorization
• Maintain ongoing tracking and appropriate documentation of referrals & authorizations while verifying all insurance requirements for procedures and admissions have been met
• Monitor patient waiting areas for extended wait times and patient related problems
• Use a multitude of sources to ensure that the authorization number(s) provided by providers are correct, and that the location/dates authorized are appropriate for the patients encounter/location
• Ensure that services ordered are within benefit plan and approved for procedure / testing point of service as appropriateVerify medical necessity guidelines are met and take appropriate action as needed when guidelines are not met
• Monitor patient length of stay to ensure adequate coverage and secure authorization for extended stay / set up payment arrangements as appropriate
• Provide follow up when insurance denials are received and provide required documentation or information requested by insurers to facilitate payment
• Develop thorough knowledge of all medications / procedures performed and payer authorization requirements for each
• Understand insurance requirements for prior authorization / authorization. and serve as primary resource to staff regarding authorization requirements
• Serve as principal contact for clinical and / or department staff regarding prior authorization / authorization process for services to be rendered at Glens Falls Hospital or Glens Falls Hospital Health Centers
• Advise providers and their clinical staff when issues arise relating to obtaining prior authorization
• Stay informed and research information regarding new procedures and insurance coverage requirements
• Interact directly with providers and / or their clinical staff as necessary
  
  

Education/Accredited Programs

• High school diploma/GED equivalent required
• Successful completion of an AAS in health administration, business, finance, or related field preferred
  
  

Experience/Abilities

• Four (4) years of insurance experience in a healthcare environment preferred in lieu of an associate degree
• Baseline knowledge of medical terminology preferred
• Knowledge of CPT and ICD coding desired
• Knowledge of Medicare and third-party payer regulations desired
• Excellent computer, phone and customer service skills required
• Excellent written and verbal communication skills required
• Ability to multitask and meet deadlines
• Ability to problem solve, trouble shoot issues as they arise, and work independently
• Ability to type 60 WPM
• Strong organizational skills required
  
  

Communities We Serve

Located in the foothills of the beautiful Adirondack mountains, Glens Falls is conveniently located a short drive away from the capital region and Lake George. Work at the top of your profession and jumpstart your next career here at Glens Falls Hospital!

All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law.

Salary Range

The expected base rate for this Glens Falls, New York, United States-based position is $17.25 to $25.87 per hour. Exact rate is determined on a case-by-case basis commensurate with experience level, as well as education and certifications pertaining to each position which may be above the listed job requirements.

Benefits

Glens Falls Hospital is committed to providing our people with valuable and competitive benefits offerings, as it is a core part of providing a strong overall employee experience. A summary of these offerings, which are available to active, full-time and part-time employees who work at least 30 hours per week, can be found here.

Primary Location

US-NY-Ballston Spa

Job

Administrative/Clerical

Schedule

Regular

Job Type

Full-time

Scheduled Time of Shift (format example: 7a-7p, 8a-4:30p)

Days

Job Posting

Jan 10, 2025, 1:01:41 PM