Morgan Stephens
Referral/Authorization Specialist - (Remote)
Morgan Stephens, Columbus, Ohio, United States, 43224
Job Title:
Referral / Authorization Specialist
(Healthcare Experience REQUIRED)
Location:
Must live in Eastern Time Zone
Pay:
$24.00 per hour and up
Work Arrangement:
100% Remote
Experience Required:
1+ Years of Relevant Experience
Company Overview:
Our organization is committed to enhancing the healthcare journey for our members. We are dedicated to delivering accessible, high-quality care tailored to the unique needs of our communities. As a Referral / Authorization Specialist, you will play a crucial role in ensuring our members promptly receive the services they require.
Summary:
We are seeking a highly organized and detail-oriented individual to join our team. The ideal candidate will possess extensive knowledge of prior authorization and referrals processes, medical terminology, and ICD-10 coding. The primary responsibilities include processing faxes, building authorizations, and effectively communicating with healthcare providers. This role requires a strong understanding of medical billing codes, computer literacy, and the ability to ensure compliance with State and Federal healthcare regulations.
Essential Functions:Authorization Processing:Provide accurate and efficient computer entries for authorization requests and provider inquiries through phone, mail, or fax.Verify member eligibility and benefits to facilitate appropriate authorization procedures.Determine provider contracting status and ensure appropriateness for the requested services.Assess diagnosis and treatment requests, assigning appropriate billing codes (ICD-10 and/or CPT/HCPC codes).Verify coordination of benefits (COB) status for members.
Inpatient Hospitalization Oversight:Verify and maintain inpatient hospital census, including admissions and discharges.Coordinate with healthcare providers to ensure timely and accurate information exchange.
Communication and Triage:Communicate with healthcare providers, both verbally and in writing, to gather necessary information and address inquiries.Triage members and information to the appropriate Health Care Services staff, ensuring seamless workflow.
Data Entry and Database Management:Enter relevant data into systems accurately and promptly.Maintain up-to-date and comprehensive records of authorizations and related information.
Eligibility and Benefits Verification:Check eligibility for members requiring hospitalization or utilization review for other healthcare services.Verify and communicate benefits information to relevant stakeholders.
Qualifications:Proficiency in medical terminology, ICD-10 coding, and prior authorization processes.Strong computer literacy and experience with healthcare databases.Excellent organizational and multitasking skills.Effective communication skills, both written and verbal.Detail-oriented with a commitment to accuracy.Ability to work collaboratively in a team-oriented environment.Education and Experience:
High school diploma or equivalent; Bachelor's degree in a related field is a plus.Previous experience in health care services coordination or a related role.Familiarity with State and Federal healthcare regulations.Qualifications:
Education:
High school diploma or equivalent. Additional college coursework in healthcare administration or related fields is advantageous.Experience:
1+ year of experience in referral and authorization coordination within the healthcare or managed care sector.Technical Proficiency:
Proficient in using computer systems and software, particularly Microsoft Office and relevant healthcare management applications.Communication Skills:
Strong verbal and written communication skills, with the ability to interact professionally with providers and internal teams.Organizational Aptitude:
Excellent organizational and time-management skills for managing multiple referrals and authorizations simultaneously.Attention to Detail:
A keen eye for detail is essential to ensure the accuracy of referral and authorization processes.Problem-Solving:
Effective problem-solving skills to address issues and discrepancies.Adaptability:
Ability to adapt to changes in policies and procedures.Team Player:
Collaborative and willing to work as part of a team to achieve shared objectives.
Referral / Authorization Specialist
(Healthcare Experience REQUIRED)
Location:
Must live in Eastern Time Zone
Pay:
$24.00 per hour and up
Work Arrangement:
100% Remote
Experience Required:
1+ Years of Relevant Experience
Company Overview:
Our organization is committed to enhancing the healthcare journey for our members. We are dedicated to delivering accessible, high-quality care tailored to the unique needs of our communities. As a Referral / Authorization Specialist, you will play a crucial role in ensuring our members promptly receive the services they require.
Summary:
We are seeking a highly organized and detail-oriented individual to join our team. The ideal candidate will possess extensive knowledge of prior authorization and referrals processes, medical terminology, and ICD-10 coding. The primary responsibilities include processing faxes, building authorizations, and effectively communicating with healthcare providers. This role requires a strong understanding of medical billing codes, computer literacy, and the ability to ensure compliance with State and Federal healthcare regulations.
Essential Functions:Authorization Processing:Provide accurate and efficient computer entries for authorization requests and provider inquiries through phone, mail, or fax.Verify member eligibility and benefits to facilitate appropriate authorization procedures.Determine provider contracting status and ensure appropriateness for the requested services.Assess diagnosis and treatment requests, assigning appropriate billing codes (ICD-10 and/or CPT/HCPC codes).Verify coordination of benefits (COB) status for members.
Inpatient Hospitalization Oversight:Verify and maintain inpatient hospital census, including admissions and discharges.Coordinate with healthcare providers to ensure timely and accurate information exchange.
Communication and Triage:Communicate with healthcare providers, both verbally and in writing, to gather necessary information and address inquiries.Triage members and information to the appropriate Health Care Services staff, ensuring seamless workflow.
Data Entry and Database Management:Enter relevant data into systems accurately and promptly.Maintain up-to-date and comprehensive records of authorizations and related information.
Eligibility and Benefits Verification:Check eligibility for members requiring hospitalization or utilization review for other healthcare services.Verify and communicate benefits information to relevant stakeholders.
Qualifications:Proficiency in medical terminology, ICD-10 coding, and prior authorization processes.Strong computer literacy and experience with healthcare databases.Excellent organizational and multitasking skills.Effective communication skills, both written and verbal.Detail-oriented with a commitment to accuracy.Ability to work collaboratively in a team-oriented environment.Education and Experience:
High school diploma or equivalent; Bachelor's degree in a related field is a plus.Previous experience in health care services coordination or a related role.Familiarity with State and Federal healthcare regulations.Qualifications:
Education:
High school diploma or equivalent. Additional college coursework in healthcare administration or related fields is advantageous.Experience:
1+ year of experience in referral and authorization coordination within the healthcare or managed care sector.Technical Proficiency:
Proficient in using computer systems and software, particularly Microsoft Office and relevant healthcare management applications.Communication Skills:
Strong verbal and written communication skills, with the ability to interact professionally with providers and internal teams.Organizational Aptitude:
Excellent organizational and time-management skills for managing multiple referrals and authorizations simultaneously.Attention to Detail:
A keen eye for detail is essential to ensure the accuracy of referral and authorization processes.Problem-Solving:
Effective problem-solving skills to address issues and discrepancies.Adaptability:
Ability to adapt to changes in policies and procedures.Team Player:
Collaborative and willing to work as part of a team to achieve shared objectives.