Referral​/Prior Authorization Specialist

TITLE:

REFERRAL and PRIOR AUTHORIZATION SPECIALIST

STATUS: NON-EXEMPT

LINES OF AUTHORITY:
This position is supervised by the Show Low Medical Office Manager.

POSITION SUMMARY:

The Referral/Prior Authorization Specialist works with the providers and staff to coordinate patient referrals and medication prior authorizations for medical and psychiatric services provided at ChangePoint Integrated Health. This position also provides a variety of clerical and general office support dutiesto facilitate operations of the department and care of patients. PRINCIPLE DUTIES/RESPONSIBILITIES:

• 1. Adhere to personnel policyand comply with agency requirements for ethical and professional behavior.
• 3. Obtains authorizations from various insurance companies according to their plan requirements.
• 4. Communicates status of referrals to patient.
• 5. Tracking and following up to close theloop making sure patients have seen referred provider and records are received.
• 6. Obtains medication prior authorizations for both psychiatric and medical services provided.
• 7. Communicates status ofprior authorization to patient.
• 8. Scanning and indexing documents into patient charts.
• 9. Answer telephones on adaily basis.
• 10. Provides back up for clerical staff as needed.
• 11. Must participate inmeetings as required.
• 12. This position requires positive and active support of the company, the customer and the co-worker.
• 13. Performs other dutiesas assigned by the Office Manager.

PRIMARY CONTACTS:

Frequent interaction with customers and administrative personnel.

POSITION REQUISITES:
Qualifications and Experience

Required:

• High School Diploma/GED.
• Valid Arizona Driver's License.
• Comply with a Drug Free Workplace.
• Two Years' Experience in Data Entry - preferred.

Skills and Abilities

Required:

• Fluent in English both verbally and in writing.
• Literate.
• Able to prioritize own workload.
• Able to effectively employ analytical and problem-solving skills.
• Able to type accurately;perform numeric calculations; computer skills.
• Phone courtesy and customer service skills.

Preferred:

• Effective time management skills.
• Able to work forty (40) hoursper week.

WORKING CONDITIONS:

Physical Requirements

Sitting for extended periods oftime at a desk/computer; less frequently, walking, lifting and reaching.

Visual capacity necessary to fulfill documentation, responsibilities of job.

Able to hear ordinary conversation and phone communications.

Equipment Operation

Able to correctly use office equipment (e.g.: calculator, copier, PC/word processor, fax) and trouble shoot common office equipment problems.

Able to employ multi-line telephone system.

Environmental Conditions

Air conditioned and/or heated office setting.

Accommodation(s)

Will accommodate as appropriate and reasonable.

CONFIDENTIALITY LEVEL:

I understand that State and Federal Laws strictly prohibit unauthorized access, use, modification,disclosure, or destruction of confidential, sensitive or protected health information. Penalties for violation may include ChangePoint disciplinary action, including termination of employment, and/or criminal or civil action.