Schedule - Shift - Hours: Full Time - DaysPRIMARY FUNCTION: Obtain authorization from insurance companies to assist patients in the referral process.
SUPERVISION RECEIVED: Reports directly to Referral Manager.
SUPERVISORY RESPONSIBILITIES:None.
TYPICAL WORKING CONDITIONS: Work may require sitting for long periods of time, manual dexterity sufficient to operate a keyboard, telephone, and other office equipment as necessary. It is necessary to view and type on computer screens for long periods and to work in a high-volume, fast-paced environment. Ability to work remotely is required.
ESSENTIAL FUNCTIONS OF THE JOB: (This list may not include all of the duties that may be assigned.) Obtain authorizations for all referral requests received as assigned.Review and understand documentation required by insurance companies to obtain authorization, including clinical notes, lab results, consult notes.Utilize insurance web portals to obtain authorizations as required.Accurately document referral details, including status, authorization dates, authorization number, specialist/facility, and other relevant information per policy.Effectively communicate updates in referral status with patients, clinicians, and office site staff.Interact professionally with specialists/facilities and insurance plan representatives.Remain current with company, health plan, and specialist requirements.Prioritize use of preferred specialist/facility within the EHR.Meet productivity standards as determined by the management team.Manage workloads within notification and request bins in EHR to meet established timeframe expectations.Work collaboratively with department team members to ensure coverage.Manage high-priority notifications and requests appropriately.Review and update requests pending authorization daily.Communicate and collaborate effectively with the Referral Manager and team members.Education Requirements: High School diploma or equivalent.
Location: Monterrey, Mexico.
Knowledge, Skills & Abilities: Knowledge of medical terminology, grammar, spelling, and punctuation to type correspondence. Knowledge of the insurance industry. Skills in operating a computer, fax, and photocopy machine. Ability to read, understand, and follow oral and written instructions. Ability to sort and file materials correctly by alphabetic or numeric systems. Ability to speak clearly and concisely. Ability to establish and maintain effective working relationships with patients, employees, and the public. Typing ability of 40 w.p.m., word processing, and computer experience.
Experience: One year experience in a medical office and/or referral coordinator experience preferred.
The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills, efforts, or working conditions associated with the job. It is intended to be an accurate reflection of the general nature of the level of the job.
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