Referral Authorization Management Specialist- Corporate Billing Office

Job Title: Referral/Auth Mgmt. Specialist

Non-Exempt

Job Code: 170301

Primary Purpose:

The Referral/Auth Mgmt. Specialist is accountable for a wide range of duties relating to the referral process as defined by the initial Scope of the Referral Mgmt-Auths Department. It is expected that the role of the Referral/Auth Mgmt. Specialist will evolve as the department expands and the central department absorbs additional office functions. The position is responsible for multiple cross-functional activities including: 1) Scheduling all specialty referrals (I.e. patient consultations, new patient visits and office visits), 2) Scheduling diagnostic tests, 3) Pre-certifications for diagnostic tests and procedures and 4) Pre-Authorizations for all specialist referrals. The Central Specialist will be expected to interact professionally with patients, SEP, independent physician offices, and insurance companies.

EDUCATION:

Please describe the minimum education REQUIRED to perform the position duties.

Minimum: H.S. Diploma/GED

Desired: Medical Office Experience

YEARS OF EXPERIENCE:

Please describe the minimum amount of experience required to perform the position duties.

REQUIRED SKILLS AND KNOWLEDGE:

Ability to manage and prioritize multiple tasks, strong working knowledge of Referrals, Pre-certification/ Pre-authorization, Customer Service, Outlook and the ability to learn other computer skills. Must have good organizational skills and work professionally with doctors, hospital administration, management, SEP employees and the public.

OTHER REQUIRED SKILLS AND KNOWLEDGE:

  1. Knowledge of current practice management and electronic medical record systems- Epic preferred (training provided).
  2. Extensive knowledge of insurance plans accepted by SEP.
  3. Extensive knowledge of referral process for insurance plans accepted by SEP.
  4. Experience in a physician practice is preferred.
  5. Demonstrated ability to work successfully in a team-based decision-making culture.
  6. Demonstrated ability to work independently resulting in effective outcomes and on-time performance.
  7. Experience in planning and coordinating multi-disciplinary communications strategies, strategic initiatives, and events.
  8. Must respond and follow through to requests from customers promptly.
  9. Must work carefully and precisely with attention to detail.
  10. Must utilize resources wisely.
  11. Performs duties willingly and with initiative. Shares necessary information so co-workers can do the same.
  12. Cooperates with other departments and work groups.

LICENSES AND CERTIFICATIONS:

List any licenses and/or certifications required to perform this position.

N/A