Referral & Authorization Specialist

 Our Mission

All of us, for each of you, every time.

Our Vision

Together, serving as the trusted regional healthcare partner.

Our Values 

Listen~Love~Respect~Excel~Innovate

At Samaritan Healthcare we are dedicated to providing healthcare services to the community that we serve. We are committed to providing the very best work environment for our professionals and the very best care to our patients. The Referral & Authorization Specialist is responsible for assisting patients by obtaining necessary authorization, coordinating referral appointments and working with insurance companies and care providers to share essential patient information. This position performs general administrative or clerical tasks such as answering phone calls and emails, maintaining patient records, and verifying insurance information before appointments.

This is a full-time position working Monday-Friday from 7:00am-4:00pm.

ESSENTIAL FUNCTIONS

1. Ensure prior authorizations and referrals are addressed in a timely manner to promote continuity of patient care.
2. Confirm all insurance information provided is promptly verified.
3. Identify health plan requirements for prior authorization (PA). Gather necessary documentation and submit electronically when possible.
4. Work with patients to arrange referrals to outside facilities.
5. Set expectations and serve as a resource to patients regarding PA and referral process, answering questions the same day.
6. Follow up with health plan at regular intervals for status updates.
7. Process imaging authorizations.
8. Expedite stat authorizations or referrals.
9. Utilize vetted resources to help with PA or referral.
10. Keep ordering provider/office professionals abreast of delays or denials.
11. Coordinate peer to peer reviews.
12. Compose appeal letters.
13. Support Patient Financial Services in appeal efforts when needed.
14. Maintain ongoing tracking and documentation for prior authorizations and referrals to promote team awareness.
15. Ensure HIPAA compliance when sharing patient information to authorized care providers.
16. Stay up to date with insurance coverage limitations/exclusions, new procedures and coding updates.
17. Participate in continuing education opportunities.
18. Maintains professional growth and development through seminars, workshops and professional affiliations to keep abreast of latest trends in field of expertise.
19. Ensures no injuries to self or others by following safe work practices and policies. This includes, but is not limited to: security and safety, understanding of chemical Safety Data Sheets (SDS), equipment, infection control, fire, disaster, safe lifting and body mechanics.
20. Ensures self-compliance with organization policies and procedures, as well as labor agreements.
21. Ensures the interface with team members and other support groups is conducted in a courteous and efficient manner conducive with the organization's values.
22. Conducts self in a professional manner and ensures personal appearance meets the standards necessary to perform the job function while representing the organization.
23. Ensures that additional accountabilities, as may be required by management, be handled in a manner necessary to meet organizational standards.

WORK ENVIRONMENT

The professional in this position reports to the Director of Operations. The professional in this position will work closely with other Samaritan professionals within various departments.

EDUCATION & EXPERIENCE

• Education:
  1. Associates degree; experience will be considered in lieu of education.
• License

1. Active license in the State of Washington as a Medical Assistant-Certified preferred.

• Experience:
  1. Minimum of two (2) years of experience in a medical or health insurance field required.
  2. Experience working in a clinic setting providing support to providers in medical specialties preferred.
• Skills/Competencies:
  1. Basic medical terminology
  2. Demonstrates competency on equipment listed on department specific checklist.
  3. Critical thinking skills: Seeks resources for direction, when necessary. Performs independent problem solving. Decision-making is logical and deliberate.
  4. Performs actions that demonstrate accountability. Exercises safe judgment in decision-making.  Practices within legal and ethical guidelines. 
  5. Demonstrates competency in ability to care for customers/patients across the age continuum.

PHYSICAL REQUIREMENTS

1. Occasional lifting, reaching, kneeling, bending, stooping, pushing and pulling.
2. Occasional heavy lifting (lift/carry up to 50 lbs.).
3. Manual dexterity and mobility.
4. Ability to read and understand patient charts, provider orders, tests results, etc.
5. Ability to communicate using verbal and/or written skills for accurate exchange of information with physicians, nurses, health care professionals, patients and/or family, and the public.

As a Samaritan Healthcare professional, you will be asked to carry out the Mission, Vision, Values, and Strategy of Samaritan Healthcare, personifying service and operational excellence including the creation and maintenance of the best patient, professional, physician, and student experience.