Referral & Prior Auth Spec
With general direction and latitude for initiative and judgement, performs routine and non-routine administrative duties to monitor and process department’s referrals. Is accountable for completing all referrals in a manner compliant with University Standards. The majority of referrals processed are those received by the department, but also processes those prescribed by the department’s providers.
In processing referrals for receiving providers as wells as prescribing providers, prioritizes referrals by following and applying standard policies, procedures and practices.
Employs multiple tracking mechanisms to ensure that referral approvals and appointments are obtained in a timely manner so that patients are always cleared for their appointment prior to their arrival.
Enters progress notes and other pertinent information into the electronic medical record based on application of practices and procedures.
Identifies by applying knowledge of provider sub-specialties, the appropriate provider with whom to make an appointment.
Reviews referrals to determine if insurance authorization has been obtained. If no authorization, returns referral to referring provider’s office via electronic medical record system. Schedules required ancillary services needed to prepare for appointment. Follow up with patient to ensure completeness.
Determines if preliminary testing (i.e. imaging) is needed based on office practices and procedures and is responsible for explaining to patient, assisting with scheduling and for completeness prior to office visit.
Anticipates, gathers and sends information to insurance carrier and/or provider needed for obtaining referral or prior authorization for required preliminary testing.
Completes the referral request in the electronic medical records system once the patient has been seen by entering a new status as closed.
Other duties as assigned.
Associates Degree in Medical, Secretarial or related field preferred
3 years of relevant experience Or equivalent combination of education and experience required
Medical terminology, surgical/appointment scheduling, EMR required
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How To Apply
All applicants must apply online.
EOE Minorities/Females/Protected Veterans/Disabled
Location: Medical Faculty Group
Full/Part Time: Full-Time
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