Referrals and Authorization Specialist
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Job Location:
Portland, TX - USA
Monthly Salary:
Not Disclosed
Posted on:
Yesterday
Vacancies:
1 Vacancy
Job Summary
Join Martins Point Health Care - an innovative not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force ofpeople caring for people Martins Point employees are on amission to transform our health care system while creating a healthier community. Martins Point employees enjoy an organizational culture of trust and respect where our values - taking care of ourselves and others continuous learning helping each other and having fun - are brought to life every day. Join us and find out for yourself why Martins Point has been certified as a Great Place to Work since 2015.
Position Summary
The Referral and Authorization Specialist plays a key role in ensuring patients at Martins Point Health Care receive timely and coordinated care. As a part of the Centralized Services team this position works collaboratively with the health care centers and health plans to manage the end-to-end referral and authorization process. The specialist acts as a liaison between internal providers external specialists pharmacies and facilities to ensure that all referrals pre-certifications and prior authorizations are accurately processed in support of quality care delivery.
Job Description
PRIMARY DUTIES AND RESPONSIBILITIES
Employees are expected to work consistently to demonstrate the mission vision and core values of the organization.
- Responsible for the processing and management of patient referrals prior authorizations and ancillary orders to/from specialists insurance carriers and facilities
- Coordinates and communicate with internal care teams to ensure timely handling of referral requests.
- Obtains required prior authorizations and pre-certifications from health plans in compliance with payer guidelines.
- Complies with all service standards organizational policy and standard operating procedures for the processing and management of all patient referrals and prior authorizations.
- Ensures accurate documentation and tracking of all referral and authorization activities in EHR.
- Monitors referral or authorization status and follow up with providers or health plans as needed to avoid delays in care.
- Serves as a resource for patients and care teams regarding referral and authorization processes.
- Maintains confidentiality and comply with HIPAA regulations and organizational policies.
- Communicates updates from specialty partners in the community with staff and providers.
POSITION QUALIFICATIONS
There are additional competencies linked to individual contributor provider and leadership roles. Please consult with your leader to discuss additional competencies that are relevant to your position.
Education
- HS Diploma or equivalent
Experience
- 3 years experience working in a medical environment with patient registration billing insurance processing or appointment scheduling
- Referral or authorization experience preferred
Knowledge
- Medical terminology
- Strong organizational communication and customer service skills.
- Ability to work collaboratively in a fast-paced team-oriented environment.
- Knowledge of payer authorization and referral requirements
- Athena experience
Skills
- Basic computer skills: Word Excel etc.
- Positive interpersonal skills
- Collaborative
- Strong attention to detail
Abilities
- Ability to handle difficult conversations with patients and internal customers
- Problem solving
- Customer focused approach
This position is not eligible for immigration sponsorship.
We are an equal opportunity/affirmative action employer.
Martins Point complies with federal and state disability laws and makes reasonable accommodations for applicants and employees with disabilities. If a reasonable accommodation is needed to participate in the job application or interview process to perform essential job functions and/or to receive other benefits and privileges of employment please contact
Do you have a question about careers at Martins Point Health Care Contact us at:
Required Experience:
IC
Key Skills
- Sales Experience
- Crane
- Customer Service
- Communication skills
- Heavy Equipment Operation
- Microsoft Word
- Case Management
- OSHA
- Team Management
- Catheterization
- Microsoft Outlook Calendar
- EHS
