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Medical Scheduler/Prior Authorization Rep

N. Little Rock, AR · Healthcare

Medical Scheduler/Prior Authorization Rep
North Little Rock, AR

Organizes and coordinates scheduling patient referrals to specialists, agencies and outpatient facilities.

JOB DUTIES & RESPONSIBILITIES

  • Obtain prior authorization(s) when required and referral approvals from insurance carriers within 24 hours of receipt of request.
  • Coordinate and schedule patient referrals to specialist providers and health care agencies.
  • Clearly communicate with the patient who the patient is being referred to and why, what their insurance will cover and whether there are co-pays or other charges, what documentation needs to be done prior to the visit, how the appointment should be made, and information to bring to the visit. 
  • Maintain documentation of sent referrals and status of scheduling referrals, for tracking. Help address barriers that delay patient follow-through with referred specialty visits.  
  • Track closure of referrals: maintain documentation of status for received medical records, including consult notes, following referred specialty visits.
  • Follow-up with specialists about information delays. Participate in chart audits to monitor referral tracking.
  • Enter data of all demographic and insurance information. 
  • Inform uninsured and under-insured patients of all payment options including community assistance program applications. 
  • Responsible for obtaining pre-certification and prior authorization numbers for surgical procedures.
  • Must interact with various insurances/third party payers accurately and timely to ensure authorization is obtained and documented; gathering and maintaining patient demographic and financial information when necessary.
  • Coordinate with provider offices, and the billing department to facilitate proper reimbursement. Guarantee adherence to requirements, guidelines, and policies of various third party payers of precertification.
QUALIFICATIONS:

To perform this job successfully, an individual must be able to perform each duty described above satisfactorily. The following requirements are representative of the knowledge, skill and/or ability required for this job.
  • Ability to write routine reports and correspondence.
  • Proficiency in Microsoft Word, Microsoft Excel, and e-mail. Prefer skills in using referral software, using health plan web sites and familiarity with electronic medical records.
  •  High level of confidentiality required. Ability to work independently and within a team.
  • Room patients
Education:
High school diploma or general education degree (GED); or one year related experience and/or training, for example, in a customer service oriented environment; or equivalent combination of education and experience.
Shannon Steed
Apex Staffing, Inc.

Please contact me with any questions:

Email:
shannon@apexstaffing.net

Phone:
Fax:

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