What are the responsibilities and job description for the Referral & Prior Authorization Specialist position at UW Health in Northern Illinois?
Pay Range : $16.45 - $22.21 / hour
Additional components of compensation may include :
Evening & night shift differential
- Overtime
- On-call pay
Benefits information :
At UW Health in northern Illinois, you will have :
POSITION SUMMARY :
The Referral and Prior Authorization Representative is responsible for insurance verification, determining prior authorization requirements, obtaining referrals for outpatient services and benefit counseling functions. The position is accountable for multiple electronic work queues in performing their duties. The incumbent works with internal and external customers, including patients, families, third party payers, clinical staff, and review organizations to accomplish their objectives.
This position represents UW Health and the Revenue Cycle team by adhering and upholding the UW Health Respect for People commitments and UW Health Service Excellence Standards of Behavior in providing the highest quality service to our customers. They will be friendly, knowledgeable, flexible, and reliable. They will listen to, anticipate, recognize, and satisfy our customer's needs. We will improve our Referral and Prior Authorization process while ensuring the highest level of satisfaction, keeping our promises and commitments, and demonstrating our commitment through respect, knowledge, responsiveness, and courtesy. They will support their co-workers, engage in positive interactions, demonstrate friendliness by smiling and making eye contact when greeting all customers, provide helpful assistance in anticipating and responding to the needs of our customers and staying calm under pressure to deal effectively with difficult people.
EDUCATION / TRAINING :
Minimum :
N / A
Preferred :
High School Diploma or GED.
LICENSURE / CERTIFICATION :
Minimum :
N / A
Preferred :
N / A
EXPERIENCE : Minimum :
N / A
Preferred :
2 years experience in the healthcare or related field with emphasis on insurance prior authorization and referral processes.
REQUIRED SKILLS, KNOWLEDGE, AND ABILITIES :
Must be detail oriented and accurate.
Excellent customer service, interpersonal and organizational skills.
Ability to use good judgments in highly emotional and demanding situations.
Ability to react to frequent changes in duties and volume of work.
Excellent oral and written communication skills.
Ability to listen empathetically.
Ability to logically and accurately organize details.
Ability to manage multiple tasks with ease and efficiency.
Self-starter with a willingness to try new ideas.
Ability to work independently with minimal supervision and be result oriented.
Positive, can-do attitude coupled with a sense of urgency.
Effective interpersonal skills, including the ability to promote teamwork.
Strong problem solving skills.
Ability to ensure a high level of customer satisfaction including employees, patients, visitors, referring physicians and external stakeholders.
Excellent computer operating skills (keyboard, mouse).
Ability to use various computer applications including EPIC and MS Office.
Basic math skills and knowledge of general accounting principles.
Maintains confidentiality of sensitive information.
Broad knowledge of health care business office practices and principles.
Knowledge of medical and insurance terminology, CPT, ICD coding structures.
Knowledge of Business Office policies and procedures.
Ability to type 35 words per minute preferred.
MAJOR RESPONSIBILITIES :
Contacts insurance companies to obtain benefit information and requirements related to pre-certification, pre-existing condition clauses, referral requirements.
Enters benefit and pre-certification information into Health Link.
Determines the appropriate payer plans and files orders to drive insurance proration's and discounts to ensure accurate and timely reimbursement.
Contacts appropriate physician office or department so appointment scheduling may proceed.
Provides clinical documentation to insurance companies to support medical necessity of scheduled services.
Explains insurance benefits to patients.
Obtains a financial statement and financial responsibility form as necessary
Collects deductibles and prepayments as required.
Refers patients with limited insurance or high financial liability to a Financial Counselor, and refers patients to the Government Program Coordinator to determine if referral to alternate funding sources is appropriate.
Educates medical staff and other appropriate UW Health Health System personnel regarding prior authorization and referral processes.
Researches and appeals payment denials, as appropriate.
Our Commitment to Diversity, Equity, and Inclusion
UW Health is committed to being a diverse, inclusive and anti-racist workplace and is an Equal Employment Opportunity, Affirmative Action employer. Our integrity shines through in patient care interactions and our daily work practices as we work to embrace the knowledge, unique perspectives and qualities each employee and faculty member brings to work each day. Applications from Black, Indigenous and People of Color (BIPOC) individuals, LGBTQ and non-binary identities, women, persons with disabilities, military service members and veterans are strongly encouraged. EOE, including disability / veterans.
Salary : $16 - $22
