Reports to the Centralized Scheduling, Referral and Authorization Manager and works under the direction of the Centralized Referral and Authorization Supervisor under general supervision and according to established policies and procedures. Responsibilities include evaluating designated referred services for authorization needs based on government and commercial payor requirements. Disseminating all clinical and coding supporting documentation to effectively complete the authorization process to ensure appropriate reimbursement. In addition, this position provides exceptional customer service during every encounter with patients, families, visitors and BMG associates by communicating with empathy and clarity regarding the details of the next step in care for the customer.
MISSION, VALUES and SERVICE GOALS
MISSION: We deliver outstanding care, inspire health, and connect with heart.
VALUES: Trust. Respect. Integrity. Compassion.
SERVICE GOALS: Personally connect. Keep everyone informed. Be on their team.
JOB SPECIFICATIONS
Education and Experience
The knowledge, skills and abilities as indicated are normally acquired through the successful completion of an Associate's Degree in Business or Health Care related field and one year medical authorization or related experience; or, in lieu of a degree, completion of a high school diploma or equivalent and three years medical authorization or related experience. Successful completion of an approved Medical Assistant Program with successful completion of the Certification Exam or equivalent medical office experience is preferred. Medical terminology, ICD-10, CPT, prior authorizations, third party payors and prior authorization processes is required.
Working knowledge of Microsoft Office: Outlook, Excel and Word.
Knowledge & Skills
Demonstrates well developed communication skills to communicate effectively and clearly to a variety of internal and external contacts.
Demonstrates analytical skills necessary to solve problems and interpret data.
Promotes collaboration and innovation in the clinical services to ensure an interdisciplinary approach to improving healthcare delivery and the quality of patient care.
Must be tactful in handling patient problems often of a highly personal and confidential nature.
Must be able to maintain professionalism during potential frustrating interpersonal situations.
Demonstrates a high knowledge level of procedures; including knowledge of CPT codes and ICD-10 Codes.
Demonstrates a working knowledge (referrals) high knowledge (prior authorization) of insurance network guidelines to ensure the referral is scheduled in accordance with customer's insurances rules and regulations
Exhibits a high level of understanding of payor requirements to effectively navigate the authorization process via website, fax or phone.
Knowledge of insurance and maintains up to date knowledge and stays abreast of changes and updates as they occur.
Possesses analytical skills necessary to apply knowledge and evaluate clinical information to resolve denials through various, complex levels of appeal.
Working knowledge of Microsoft Office: Outlook, Excel and Word
Possesses strong customer service, communication, organizational and analytical skills.
Working Conditions
Assigned hours within your shift, starting time, or days of work are subject to change based on departmental and/or organizational needed.
May need to travel to other Beacon locations, and may be required to work evening hours.
Working space is frequently congested by other personnel.
Constantly exposed to noise and distraction.
Physical Demands
Requires the physical ability and stamina to perform the essential functions of the position.
Sitting for long periods of time in front of a computer monitor
