What are the responsibilities and job description for the Referrals & Authorizations Representative position at KIDNEY SPECIALISTS OF SOUTHERN NEVADA?
Job Details
Referrals & Authorizations Representative
Kidney Specialists of Southern Nevada (KSOSN) provides comprehensive kidney care and a full spectrum of kidney disease management resources for residents of Southern Nevada. Our care team educates and empowers patients who are living with kidney pain, infections, stones, and other kidney problems. With this exciting opportunity you will be joining a seasoned team of 50 Physicians, Nurse Practitioners, and Physicians Assistants, as well as 60 team members across eight locations. We are looking for a dynamic Referrals and Authorizations Representative to join our growing team.
This position will work a 9/4 schedule. Work schedule will be Monday to Thursday, 7:30 am to 5pm OR 8am to 5:30pm and Friday 8am to 12 noon. For immediate consideration please complete and sign an employment application at our website at https://www.ksosn.com/careers/.
Position Summary
The Referrals and Authorization Representative is responsible for the coordination of patient services, including referrals and authorizations. The primary purpose for this position is to perform the appropriate processes to verify patient eligibility, ensure insurance coverage, and determine if prior authorization is needed.
Essential Functions
- Serves as the primary liaison for all referrals and authorizations.
- Facilitates communication between patients, insurance carriers, and providers.
- Processes and schedules internal and external referrals; submits medical records to insurance carriers to expedite prior authorization processes.
- Requests, tracks, and obtains prior authorizations through insurance carriers and their third-party administrators.
- Reviews insurance benefits and calculates estimate costs per CPT code.
- Manages correspondence with insurance companies, physicians, specialists and patients.
- Develops and maintains relationships with all insurance carriers, representatives, and referral sources.
- Stays current on all payor changes and updates.
- Meets all referrals and authorizations service goals.
- Assumes advocacy role on the patient's behalf with the carrier to ensure approval of authorization in a timely manner.
- Updates job tools and guides.
- Maintains documentation in the patient electronic medical record (EMR).
- Other duties as assigned.
Minimum Requirements:
- Must receive the influenza vaccine every year at flu season.
- High school diploma or equivalent required.
- Minimum two (2) years of experience in referrals and authorizations required.
- Minimum two (2) years of medical assistant and/or surgery scheduler experience required.
- Prior experience working in a medical specialty setting required.
- Demonstrated knowledge and appropriate use of medical terminology required.
- Intermediate knowledge of Microsoft Office applications required.
- Must have excellent customer service, communication, organizational and interpersonal skills.
- Must be able to read, write, speak, understand, and satisfactorily communicate with others in English in person, over the phone, and via email.
Benefits
- Mon to Fri schedule
- Company-paid holidays
- Medical
- Dental
- Vision
- Paid Time Off
- Company-paid Life Insurance
- Company-paid Short-term Disability
- Company-paid Long-term Disability
- 401(k)
