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.
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
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.