Job detail

Referral/Prior Authorization Specialist - Monadnock Gastroenterology Associates - Per Diem

Monadnock Community Hospital

#Scheduling #HIPAA #Medical Terminology #EMR System #Medical Office #ICD-10 #Eligibility Verification #Per Diem

Quick overview

The specialist ensures timely and accurate use of referrals by monitoring appropriateness and medical necessity, performing telephonic support for authorizations, and coordinating referrals with insurance carriers. This role also involves processing physician referral orders, entering notes into the EMR system (eCW), and scheduling office visits based on incoming referrals.

Requirements summary

The role requires proficiency in using ICD-9/ICD-10 and CPT codes, and the ability to verify member eligibility and determine benefit coverage. Candidates must demonstrate knowledge of medical terminology and high proficiency in general medical office procedures, including HIPAA regulations.

SchedulingMedical TerminologyHIPAA RegulationsICD-10Eligibility VerificationInsurance AuthorizationReferral ManagementCPT CodesPrior AuthorizationEMR SystemeCWICD-9Telephonic SupportBenefit Coverage Determination

Job description

The referral & prior authorization specialist is responsible for ensuring the timeliness and accurate use of referrals by; monitoring appropriateness, medical necessity, and provides necessary information to obtain authorization.
Performs telephonic support for online authorization of routine services
Provides direct support to Primary Care practices and specialty care providers regarding utilization, authorization, and referral activities
Becomes proficient in the use of ICD-9/ICD-10 and CPT codes
Contacts providers with authorization, denial, and appeals process information
Assists in educating and acts as a resource to primary care practices andspecialty care providers in regards to prior authorization needs.
Verifies eligibility of members and participating status of providers
Determines member benefit coverage
Performs other duties as required
Receive, track and obtain insurance authorization from in-network and out-of-network insurance carriers for New Patient and Follow-Up visits with our medical providers.
Process physician referral orders (EMG, CT, MRI, etc.) using eCW (EMR system). This includes obtaining any insurance authorization needed.
Coordinate referrals for insurance plans that require authorization (work comp, etc). This includes obtaining any insurance authorization needed.
Accurately enter notes into eCW regarding letters or correspondence from insurance companies regarding insurance authorization or other notifications. These documents should also be scanned into the appropriate patients chart in eCW.
Calling incoming referrals and scheduling office visits based on the referral
Demonstrate and apply knowledge of medical terminology, high proficiency of general medical office procedures including HIPAA regulations.

This is a per diem position.

[http://monadnockcommunityhospital.com/wp-content/uploads/2023/08/mission-vision-values.png]

About Our Benefits

Amazing people deserve amazing benefits.

Referral/Prior Authorization Specialist - Monadnock Gastroenterology Associates - Per Diem

Quick overview

Requirements summary

Job description

About Our Benefits

Benefits

Per diem employees enjoy

About Monadnock Community Hospital

About the Monadnock Region

More openings at Monadnock Community Hospital

More district openings

Similar live jobs