Referral and Authorization Specialist

Job Summary

Under general supervision, is responsible for representing Roosevelt General Hospital (RGH) as an exemplary hospital/clinic in the region. Referral and Authorization Specialist will be the embodiment of the hospital's mission, vision and values. They will greet patients, families and hospital guests upon arrival and assist them in navigating through all aspects of their hospital visit. The position is responsible for coordinating any additional care the patient may need inside and outside of our facility.

The position is responsible for obtaining prior authorization needed for testing or services.

Essential Job Responsibilities

• Promote the mission, vision, and values of the organization
• Greet all patients, families and hospital visitors with a positive, cheerful attitude.
• Notifies the client of appointments scheduled, makes follow-up calls to off-site Providers to ensure that client kept appointment and reminds Provider to submit a Consultation Report.
• Maintains competency in obtaining and inputting medical information to and from clinical and /or other information systems including accessing information as required to complete the referral process
• Screen and schedule incoming and outgoing referrals
• Obtain prior authorization for diagnostic services and procedures.
• Answers questions from patients, clerical staff, and insurance companies
• Establish and maintain relationships with identified server providers
• Utilizes software to code ICD- and CPT codes
• Contact customers to obtain or relay account information
• Be knowledgeable on all of RGH services
• Serve as the main communications person for the department, answering and placing phone calls, taking and relaying messages for clinical staff
• Assist other members of the department as needed.

Non-Essential Functions

• Performs other duties as assigned.

Roosevelt General Hospital (RGH) is committed to providing safe, quality care to patients. Employees are required to adhere to the Values of RGH.

Integrity

• We are committed to honesty and ethical principles, where our words and actions reflect our dedication to fostering strong relationships and maintaining professional credibility.
• We take accountability for our actions and their impact on others, consistently honoring our commitments and upholding moral standards and values in every situation.

Learning

• We promote personal growth and professional excellence by embracing continuous learning through training, mentorship, and constructive feedback.
• We foster a collaborative culture driven by curiosity and critical thinking, encouraging staff to ask questions, seek answers, and share knowledge.

Innovation

• We confidently embrace changes in technology, processes, and practices, encouraging strategic risk-taking and creativity to enhance healthcare delivery, patient safety, and the quality of care.
• We collaborate with partners from other hospitals, academic institutions, industry leaders, and community organizations to promote continuous improvement and remain at the forefront of advancing healthcare outcomes.

Kindness

• We engage in open communication with patients, families, and colleagues to understand their needs and concerns, while respecting their differences and upholding their dignity.
• We foster a nurturing environment where individuals feel supported, understood, and valued, strengthening relationships, promoting growth, and enhancing the overall well-being of all.

Excellence

• We strive to be a model rural healthcare facility, setting high standards in healthcare delivery and ensuring exceptional patient satisfaction within the communities we serve.
• We take pride in our accountability and fiscal responsibility, skillfully balancing costs and outcomes to guarantee that superior patient care is always delivered.

Unity

• We collaborate across departments and disciplines to deliver effective and compassionate healthcare, working alongside patients, families, and community partners to ensure seamless coordination of care and achieve our common goals of wellness and healing.
• We prioritize open communication and mutual respect, empowering our teams to collaborate effectively by acknowledging and celebrating the unique contributions and strengths of each individual.

Qualifications

• High school graduate or equivalent
• Ability to communicate effectively
• Knowledge of medical procedures and medical terminology
• Basic to intermediate computer knowledge
• One year of medical office experience required
• Typing speed: minimum 40 wpm, computer knowledge
• Spanish speaking is preferred
• Previous customer service experience preferred
• Knowledge of CPT / ICD- coding helpful.

Professional Requirements

• Adhere to dress code, appearance is neat and clean.
• Complete annual education requirements.
• Maintain patient confidentiality at all times.
• Report to work on time and as scheduled.
• Wear identification while on duty.
• Maintain regulatory requirements, including all state, federal and local regulations.
• Represent the organization in a positive and professional manner at all times.
• Comply with all…