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Role Description

Under supervision of the Centralized Authorization and Referrals Supervisor, supports patient care in an inbound high volume call center environment seeking to provide a positive experience for each call. Answers incoming phone calls related to authorization and referrals and assists in the coordination of care for patients that are referred to a specialist and/or other services. Acts as a resource for patients and staff with authorization and/or referral related questions/problems requiring resolution. Carries out all duties while maintaining compliance, confidentiality, and promoting the mission and philosophy of the organization.

Essential Functions

• Answers incoming phone calls related to authorizations and referrals, adhering to schedule with assigned breaks and lunches.
• Maintains basic understanding of insurance authorization and/or referral requirements.
• Understands and communicates important authorization and/or referral information to patient and/or specialist in a timely manner.
• Responsible for coordinating medical record information for transmission to specialist’s office.
• Responsible for creating authorization and referral requests as needed.
• Coordinates with Primary Care Offices and Specialty offices as needed.
• Works efficiently with all departments to promote teamwork within the organization.
• Attends Authorization & Referral Meeting regularly.
• Informs management of any issues causing a delay in process.
• Adheres to all company policies, including but not limited to, OSHA, HIPAA, compliance and Code of Conduct.
• Regular and dependable attendance.
• Follows the core competencies set forth by the Company, which are available for review on CMSweb.

Other Duties and Responsibilities

• Involvement in organizational development through meeting attendance and committee involvement.
• Responsibilities occasionally may require an adjusted work schedule, overtime, and evening/weekend hours in order to meet deadlines.
• Performs other duties as assigned.

Qualifications

• Required: High school diploma or equivalent. Six (6) months or more experience working in the office of a healthcare related facility.
• Preferred: Previous experience in insurance authorizations. Previous experience in a high volume customer service environment and/or experience with Avaya phone system a plus.

Knowledge, Skills and Abilities

• Strong knowledge in business office functions and ability to serve as a resource to staff.
• Knowledge of medical insurance.
• Knowledge of medical terminology.
• Strong communication and interpersonal skills.
• Excellent computer and keyboarding skills, including familiarity with Windows and Adobe products.
• Excellent verbal and written communication skills.
• Ability to adhere to an assigned schedule with little deviation.
• Manual dexterity and sitting is required in carrying out position.
• Ability to provide excellent customer service.
• Ability to troubleshoot basic system issues.
• Ability to analyze problems, make decisions, and manage conflict.
• Ability to engage others, listen and adapt response to meet others’ needs.
• Ability to align own actions with those of other team members committed to common goals.
• Ability to manage competing priorities.
• Ability to perform job duties in a professional manner at all times.
• Ability to understand, recall, and communicate, factual information.
• Ability to understand, recall, and apply oral and/or written instructions or other information.
• Ability to organize thoughts and ideas into understandable terminology.
• Ability to apply common sense in performing job.

Work Schedule

Monday - Friday 8AM - 5PM. Remote Opportunity once in person training is completed.