Medical Office Prior Authorization & Referral Specialist - Bethlehem Pennsylvania

Company: St. Luke's University Health Network
Location: Bethlehem, Pennsylvania
Posted On: 05/04/2024

Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care.
The Practice Prior Authorization and Referral Specialist is responsible for the coordination of prior-authorizations and referral process for patients being referred for specialty care, medications, and diagnostic procedures. The specialist will secure the necessary prior authorization, then notify the patient aiding in the coordination of patient care. Receive request for patient requiring specialty care through the electronic health record (EHR), direct order by provider communication, phone, and/or fax.
Reviews patient insurance information and eligibility / verification to obtain prior authorization for specialty care and/or services.
Obtain prior authorization from insurance companies prior to services being ordered and/or rendered.
Documents in EHR prior authorization approval to ensure proper reimbursement.
Responds to written as well as telephone inquires from patients, insurances, pharmacies, other outpatient/inpatient departments, and facilities regarding planned specialty care and/or services.
Review and follow up on authorization and/or claim denials.
Consistent use of hands and fingers for typing, telephone, data entry, etc. -Stoops, bends, and reaches above shoulder level to retrieve needed materials. Prior authorization experience preferred.
TRAINING AND EXPERIENCE:
One to two years of experience in medical billing, a medical office or insurances preferred. Working knowledge of medical office procedures as well as detailed understanding of ICD 10 and CPT codes. Knowledge of regulatory standards and compliance requirements.

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