What are the responsibilities and job description for the Referral and Prior Authorization Specialist position at Hyndman Area Health Center?
Benefits:
- 401(k)
- 401(k) matching
- Competitive salary
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance
Title: Referral and Prior Authorization Specialist
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
Qualifications:
· 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
