Referral Authorization Specialist
Referral Authorization Specialist
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1 Vacancy
Job Description
Canyon Vista Medical Center
Job Title: Referral Authorization Specialist
Job Type: Full time
Reports to: Assigned Physician
FLSA: Non-exempt
Who We Are:
People are our passion and purpose. Come work where you are appreciated for who you are not just what you can do. Canyon Vista Medical Center is a 106 bed Joint Commission Accredited offering a number of specialty services. We are proud to serve our community with a Level III Trauma unit Center of Excellence for Total Joint Replacement Level I Nursery American College of Radiology Accredited Facility as well as many other state of the art services to ensure our patients are cared for.
Where We Are:
Sierra Vista Arizona is a flourishing city located 75 miles southeast of Tucson. Thanks to our year-round temperate climate affordable housing low cost of living access to healthcare and education facilities not to mention the breathtaking natural beauty of majestic mountain ranges and the San Pedro River and outdoor activities Cochise County residents enjoy an excellent quality of life.
Why Choose Us:
Health (Medical Dental Vision) and 401K Benefits for full-time employees
Competitive Paid Time Off
Employee Assistance Program mental physical and financial wellness assistance
Tuition Reimbursement/Assistance for qualified applicants
And much more
Position Summary:
The Referral Authorization Specialist is responsible for ensuring that patients are getting the care that they need in a timely manner on a daily basis this will involve processing referrals in a complete accurate and timely manner verifying that patients have received the care they require and notifying providers if patients do not follow through with referrals.
Essential Functions
- Completes pre-authorizations for all diagnostic testing therapy surgical and specialty care appointments according to insurance requirements within 3 days of issuance.
- Notifies patient when referral is approved and notifies Provider if denied or if a second opinion or additional information is required.
- All communication with patient nurse and/or Provider will be documented in the clinic EMR.
- Updates to referrals will be made in the EMR each time communication is had with patient insurance provider nurse or Provider.
- Maintains up-to-date knowledge of all health care plans and interprets and communicates plan policies and procedures to employees physicians and (patients) when they have changed.
- Identifies and attempts to resolve patients barriers to specialty care including assisting with scheduling appointments and helping to coordinate with specialist offices.
- Assists in tracking high-priority referrals to ensure patients in high-risk categories receive necessary follow-up care.
- Under the supervision of physician or nurse assists with performing patient assessments and treatments.
- Performs administrative or clerical duties as assigned including filing reception scheduling data entry and patient registration.
Nonessential Functions
- Perform other duties as assigned.
Minimum Qualifications:
Education:
- High school diploma or equivalent required.
- Two years of college preferred.
Required Skills
- Requires critical thinking skills decisive judgment and the ability to work with minimal supervision.
- Must be able to work in a stressful environment and take appropriate action.
EEOC Statement:
Canyon Vista Medical Center is committed to providing Equal Employment Opportunities for all applicants and employees and complies with all applicable laws prohibiting discrimination against any employee or applicant for employment because of color race sex age religion national origin disability genetic information gender identity sexual orientation veterans status or any other basis protected by applicable federal state or local law.
Required Experience:
Unclear Seniority
Employment Type
Full-Time
