Medical Office Prior Authorization & Referral Specialist
Company: St. Luke's University Health Network
Location: Bethlehem
Posted on: May 3, 2024
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Job Description:
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.
Please complete your application using your full legal name and
-current home address. It is highly recommended that you create a
profile at the conclusion of submitting your first application.
Keywords: St. Luke's University Health Network, Allentown , Medical Office Prior Authorization & Referral Specialist, Administration, Clerical , Bethlehem, Pennsylvania
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