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Job description
Referral & Prior Authorization SpecialistThe referral & prior authorization specialist is responsible for ensuring the timeliness and accurate use of referrals by; monitoring appropriateness, medical necessity, and provides necessary information to obtain authorization.Responsibilities include:Performs telephonic support for online authorization of routine servicesProvides direct support to Primary Care practices and specialty care providers regarding utilization, authorization, and referral activitiesBecomes proficient in the use of ICD-9/ICD-10 and CPT codesContacts providers with authorization, denial, and appeals process informationAssists in educating and acts as a resource to primary care practices and specialty care providers in regards to prior authorization needs.Verifies eligibility of members and participating status of providersDetermines member benefit coveragePerforms other duties as requiredReceive, track and obtain insurance authorization from in-network and out-of-network insurance carriers for New Patient and Follow-Up visits with our medical providers.Process physician referral orders (EMG, CT, MRI, etc.) using eCW (EMR system). This includes obtaining any insurance authorization needed.Coordinate referrals for insurance plans that require authorization (work comp, etc). This includes obtaining any insurance authorization needed.Accurately enter notes into eCW regarding letters or correspondence from insurance companies regarding insurance authorization or other notifications. These documents should also be scanned into the appropriate patients chart in eCW.Calling incoming referrals and scheduling office visits based on the referralDemonstrate and apply knowledge of medical terminology, high proficiency of general medical office procedures including HIPAA regulations.This is a per diem position.Per diem employees enjoy:Free membership to local gymPositive work environment with a supportive team and opportunities for growthRetirement savings planJoin a culture of compassion, collaboration, honesty, and respect at Monadnock Community Hospital. Our employees go above and beyond to deliver an exceptional patient experience in an atmosphere that is healthy, friendly, respectful, and personally fulfilling.The Monadnock Region offers an amazing quality of life with small and friendly towns, low crime, good schools, and clean air and water. Enjoy all-season outdoor recreation and a lively arts scene.Our small hospital is committed to diversity, inclusion, and equal opportunity employment. We welcome applications from individuals of all backgrounds and abilities.Qualifications:Behaviors:Detail Oriented: Capable of carrying out a given task with all details necessary to get the task done wellTeam Player: Works well as a member of a groupEducation:Required: High School or better.Experience:Required: Exceptional customer service Excellent computer, multi-tasking and phone skills. At least one year of pre-cert experience, including navigating websites for online benefit reviews.Preferred: Prior experience with referrals, calling patients and scheduling appointments from referrals
Worksite address
peterborough, NH, 03458, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.