What are the responsibilities and job description for the Referral and Prior Authorization Specialist position at HYNDMAN AREA HEALTH CENTER, INC.?
Benefits:
Summary:
The Patient Referral Specialist acts as a liaison between hospitals, physicians, health plans, vendors, and patients. They ensure patients have been cleared for specialty office visits.
Duties/Responsibilities:
- 401(k)
- 401(k) matching
- Competitive salary
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance
Summary:
The Patient Referral Specialist acts as a liaison between hospitals, physicians, health plans, vendors, and patients. They ensure patients have been cleared for specialty office visits.
Duties/Responsibilities:
- Maintains appointment schedule for all employed and contracted health center providers for most efficient flow of patient care.
- Schedules hospital, referral and testing appointments as requested by clinicians and provides documented follow-through with appropriate personnel and patient in a timely manner.
- Contacts and verifies appointment with patient for the following day.
- Greets patients and visitors in a courteous manner and triages to appropriate health center personnel at all times.
- Answers telephone and triages all incoming, outgoing, and inter-office calls in a professional and respectful manner – Use appropriate greeting and state you name.
- Telephone encounters documented in patient chart and sent to provider for follow-up.
- Obtains authorizations for patient referrals as patient insurance plan when necessary as part of the department team. Scans documents to chart.
- Enters and updates all patient demographic information, including insurance information, for computer system accurately at each patient visit.
- Verifies insurance information and activeness. Copies insurance card and driver’s license, ensuring current copy of insurance is in patient chart.
- Uses appropriate medical record documentation guidelines and techniques at all times.
- Supports and assists with the Patient Centered Medical Home initiative.
- Obtain prior authorization requests for medications and diagnostic imaging
- Review patient’s medical history and insurance coverage
- Screen patients for medication adherence, social determinants of health, and physical needs. Facilitate patient engagement and follow–up care.
- Communicate with referring provider and/or clinical staff for additional information as needed
- Schedule diagnostic imaging at the requested facility of patient
- Contact patients with scheduled appointment dates/times and document
- Contact pharmacies and patients with medication approvals
- Prioritize incoming authorization requests according to urgency
- Record and track diagnostic imaging orders and authorizations
- At least two years’ experience with medical records and patient referrals
- Experience preparing reports
- Ability to use and understand computer applications
- Ability to establish and maintain effective, courteous working relationships with patients, staff/team members, and others
- Ability to organize, prioritize, and problem-solve independently
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