Job Summary
We are seeking a detail-oriented and organized Authorization and Referral Representative to join our surgical spine team. This role is vital in ensuring smooth communication between patients, providers, and insurance companies by managing authorizations and referrals for physical therapy services and DME. The ideal candidate will possess strong knowledge of managed care processes, medical office procedures, and medical coding standards such as CPT & ICD-10. Experience with HIPAA compliance and insurance verification is essential to maintain patient confidentiality and facilitate accurate billing. DME and Physical therapy authorizations is a plus. This position offers an opportunity to contribute to quality patient care through efficient administrative support within a professional healthcare environment.
- The position will rotate between our Peoria office & Phoenix office.
- Schedule is Monday-Friday 8am-4:30 pm
Duties
- Obtain and process prior authorizations and referrals for various medical services such as, DME and Physical Therapy, in accordance with insurance requirements.
- Verify insurance coverage and benefits for patients to ensure eligibility for services.
- Maintain accurate and up-to-date medical records, including documentation of authorizations, referrals, and correspondence.
- Utilize medical terminology effectively to communicate with healthcare providers, insurance companies, and patients.
- Apply knowledge of CPT coding, ICD-9, ICD-10, and ICD coding to ensure proper documentation for billing purposes.
- Ensure compliance with HIPAA regulations when handling sensitive patient information.
- Assist in resolving insurance denials or delays by communicating with insurance carriers and providers.
- Maintain organized office records related to patient authorizations, referrals, and medical documentation.
- Support the office team with general administrative tasks related to managed care processes.
- Role will be a hybrid position and will share front office check in duties on various days of the week.
Qualifications
- Prior experience in a medical office setting or healthcare environment is preferred. Pain management or Spine Surgery experience preferred.
- Strong understanding of insurance verification procedures
- Knowledge of HIPAA regulations to ensure confidentiality of patient information.
- Familiarity with medical terminology and medical records management.
- Excellent organizational skills with attention to detail in documentation processes.
- Effective communication skills for liaising with healthcare providers, insurance companies, and patients.
- Office experience in a fast-paced environment is advantageous; This role is essential in supporting the overall efficiency of our healthcare services by ensuring accurate authorization processes and seamless communication between all parties involved.
Pay: From $20.00 per hour
Benefits:
- 401(k)
- Dental insurance
- Disability insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Work Location: In person
