Referral and prior authorization representative iii

• Serves as the patient referral and prior authorization specialist, with oversight of data and compliance to enterprise standards and referral and prior authorization guidelines
• Communicates regularly with patients, families, clinical and non-clinical staff, identifying barriers to appointment compliance, insurance company barriers, and tracking all assistance provided
• Accountable for planning, execution, appeals, and efficient follow-through on all aspects of the process, which has a direct, multifaceted impact (quality, financial, patient satisfaction, etc.) on patient scheduling, treatment, care, and follow-up
• Adheres to approved protocols for working referrals and prior authorizations
• Makes decisions that are guided by protocols and practices requiring some interpretation
• maintains an expert-level understanding of the department/division
• May train new staff members

• High School Diploma required
• Minimum of two years of relevant experience required, or an equivalent combination of education and experience
• Medical Terminology, experiences with appointment scheduling software and electronic medical records preferred
• Demonstrated customer relations skills required

Medical Terminology, experiences with appointment scheduling software and electronic medical records