Authorization and Referral Specialist
Job Title: Authorization and Referral Specialist
Department: Authorization and Referral
Division: MCR
FLSA Class: Non-exempt
Pay Grade:
Reports To: Director of Revenue Cycle
Supervises: N/A
Position Summary
The Authorization and Referral Specialist is responsible for friendly, courteous, professional, and informative customer service to the company’s patients seeking to schedule appointments or needing other information or service. The Authorization and Referral provides a caring and compassionate impression on all clients of the company.
Essential Duties and Responsibilities
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Provides friendly, courteous, and professional service at all time to all clients and patients
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Has an excellent understanding of telephone usage and the operation of the telephone system
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Answers in-coming telephone calls within three (3) rings and accurately directs and/or assists the caller
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Forwards calls accurately to the correct person or extension and ensures that someone is answering on the extension before passing the caller
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Demonstrates competency and proficiency with the electronic medical patient information system
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Calls patients to schedule advanced and same day appointments and accurately enters new or follow-up information into the electronic medical patient information system
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Maintains and updates any patient or telephone logs that may be requested
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Explains services and operating hours; knowledgeable about services offered
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Completes and verifies patient eligibility and authorizations
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Ensures that the referral authorization process is completed timely and accurately
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Informs and guides patients to appropriate resources
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Documents if an authorization is denied form the PCP, or the insurance company including the reason and date of services
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Schedules patient appointments for the referred service with the indicated specialist’s office, providing them with authorization information, including authorization number
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Contacts the patient informing them of the appointment information including date, time, location, and any other instructions required for the referred visit
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Maintains referral/authorization information for tracking
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Screens OB patients for presumptive eligibility for Pregnant Women (PEPW) and simplified Medicaid application
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Understands the documentation required to substantiate the financial category of the patient and is able to articulate the requirements to the patient to obtain the necessary information
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Obtains, verifies, and/or updates demographics and insurance information in the appropriate electronic patient health information systems
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Maintains open communication with the Front Desk, Nursing Department, Providers, and insurance companies
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Updates patient information into the electronic medical patient information system as needed
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Supports the goals and mission of MCR Health Services.
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Adheres to the safety policies of MCR Health Services.
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Performs other duties as assigned.
Skills
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Outstanding communication and customer service skills
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Active Listening
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Excellent written and oral expression
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Problem Solving
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Ability to multi-task
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Empathy
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Ability to maintain confidences
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Ethical
Requirements
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High School Graduate or GED equivalent.
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Minimum of six months of customer service experience in a high-volume impact environment, preferably in a healthcare field.
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Excellent customer service expertise.
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Knowledge of medical terminology preferred.
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Ability to effectively interact with customers in stressful situations
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Must be flexible, resourceful, and able to troubleshoot.
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Must be able to handle multiple projects simultaneously and set priorities.
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Must maintain a professional demeanor and appearance at all time.
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Bilingual (Spanish / English) is beneficial.
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Must possess a current valid driver’s license for the State of Florida.
Mental/Physical Demands
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Physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of the job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
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While performing the duties of this job, the employee is regularly required to drive, sit, use hands or fingers, handle or feel objects, tools, controls and talk or hear. The employee frequently is required to walk, stand and reach with hands and arms. The employee is occasionally required climb or balance and stoop, kneel, crouch, or crawl.
- The employee must occasionally lift and/or move up to 25 lbs. Specific vision abilities required by the job include vision, color vision, depth perception and ability to adjust focus.
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This job is not limited to the activities described above and this job description may be amended by management as deemed necessary
Equipment Use
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Computers and related electronic devices such as IPads, etc.
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Fax machines
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Copier machines
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Scanners
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Automobile
What you need to bring to this role:
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Minimum of High School Graduate or GED equivalent
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A minimum of 5 months of customer service experience in a high-volume impact environment in the healthcare field is preferred
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Ability to prove graduation from an accredited school
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Microsoft Office Products – Word, Excel, Outlook, PowerPoint proficiency preferred.
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Valid Government Issued ID
The Authorization and Referral Specialist is responsible for friendly, courteous, professional, and informative customer service to the company’s patients seeking to schedule appointments or needing other information or service. The Authorization and Referral provide a caring and compassionate impression on all clients of the company.
**MCR Health is a drug-free workplace. All job applicants selected for employment are required to submit to a pre-employment drug test and background check.
