Responsible for obtaining and processing all pertinent clinical information needed for the authorization/ referral of professional and medical services. Not limited to but including verifying eligibility, checking benefits, documenting physician direct referrals, pre - authorizations of certain services, via phone, fax, electronic or written requests. As part of the billing team assist with additional duties related to the billing department.

In the execution of job duties, it is the universal expectation that all tasks are performed with a patient centered focus, while also seeking opportunities to continually improve core processes. Incumbent will be scheduled based on operational need, which may include but is not limited to: holidays, extended shifts, night and/or weekend shifts, standby and/or on-call. This job description is only meant to be a representative summary of the major responsibilities and accountabilities performed by the incumbents of this job. Employees may be directed to perform job-related tasks other than those specifically presented in this description.

Reports to: Practice Manager

Essential Functions

Promptly and accurately obtains appropriate authorizations/ referrals for scheduled procedures/ office visits. Performs data entry of referral authorization, outpatient surgeries, inpatient procedures and admissions as applicable.

Posts charges for daily visits, as requested by the manager. Posts patient payments accurately.

Obtains codes, date of service, and clinical data as required by payers for determination of approval/ denial of services. Verify insurance eligibility for referral or authorization needed.

Posts EOB’s accurately and efficiently. Reverts to responsible party and makes adjustments accordingly. Follows up patient accounts and processes for collections or refunds, as needed.

Downloads electronically remitted payments and verifies accurate electronic posting to patient accounts. Obtains required information from payer for each procedure.

Remains current with authorization/ referral requirements for all participating insurance plans. Monitor and facilitate re-certification for services when necessary.

Accurately records and relays authorization/ referral approval/ denial information given by payers to all required individuals. Researches diagnostic and procedural codes, as needed.

Resolves and assists patients both on site and over the phone with questions regarding their accounts.

Non-Essential Functions

Cross trains in order to perform all assigned duties required by the department.
Assists with orientation and training of others as directed.

? High school diploma or equivalent X Preferred ? Required

Minimum Work Experience
Required - 1 year demonstrated experience obtaining Authorizations/Referrals. Preferred - 2 year demonstrated experience obtaining Authorizations/Referrals.

Required Skills
Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision. Must be able to work in a stressful environment and take appropriate action.

Knowledge of medical coding practices, including ICD-9, 10 and CPT coding.
Knowledge of and familiarity with medical terminology.