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Referral Specialist - FPO Centralized Access Center-Brentwood - Full Time - 8 Hour - Days

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About the position

Responsibilities

  • Process authorization requests for full risk and shared risk group plans.
  • Forward and track requests to Utilization Review (UR).
  • Process determinations upon return from Utilization Review.
  • Conduct research and communicate with providers for retrospective or non-communicated authorizations.
  • Assist providers and patients with process and status questions.
  • Maintain statistics and reports on authorization activity.

Requirements

  • High School Graduate or Equivalent.
  • Preferred experience in Health Maintenance Organization referrals.
  • Epic proficiency must be passed within 90 days of start date.
  • Knowledge of organization policies, procedures, systems, and objectives.
  • Knowledge of medical terminology, ICD-10, CPT, and HCPCS coding.
  • Trained in HIPAA general protocols and specific department training.
  • Proficient in Microsoft Office Products (Word, Excel, Outlook, PowerPoint).
  • Ability to maintain effective working relationships with a variety of individuals.
  • Ability to deal diplomatically with individuals under stressful situations.
  • Basic knowledge of medical terminology, anatomy, and physiology.
  • Skill in developing comprehensive reports.

Benefits

  • Competitive salary and benefit package.
  • Recognition programs such as Employee of the Month and Employee Suggestion Program.
  • Employee Success Sharing Program.
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