Referral Authorization Specialist (Full-time) - Healthcare (Boulder, CO)

Job Description

Job Description

Are you seeking a professional opportunity that offers a friendly and positive work environment where you can work with helpful colleagues?

Do you want to make a positive impact on your community while advancing your career? Look no further than Boulder Medical Center (BMC)!

BMC is a local, independent, and physician-owned medical group with over 20 primary and specialty care departments, 90 providers, and 325+ clinical and support professionals.

Since our founding by 10 physicians in 1949, we have grown and evolved to meet the needs of Boulder County and beyond.

We currently have clinics located in Boulder (2 locations), Louisville, Longmont, and Erie.

Summary :

Boulder Medical Center (BMC) is seeking customer service oriented candidates to join our Referral & Authorization team as a Referral Authorization Specialist ! This position is benefit eligible working full-time 40 hours per week Monday through Friday.

Ideal candidates for this position will have 1-2 years of experience working with insurance payers in healthcare.

Job Perks :

• Full-time employees are eligible for medical / dental / vision, flexible spending, company-paid life insurance and Short Term Disability (STD) as well as several voluntary benefit options, RTD EcoPass, 401(k), Paid Time Off (PTO) and six (6) paid holidays annually.
• Experience working in both primary care and specialty care clinics.

Job Duties :

Handles pre-certification process required by most insurance companies for inpatient / outpatient and surgical procedures;

Completes correct documentation in patient's medical chart.

• Responds to phone calls from BMC physicians, nurses, and staff with managed care insurance questions, investigates problems or inquiries by contacting appropriate insurance company, and communicates action or resolution to staff in a timely and professional manner.
• Answers routine managed care insurance questions from patients referring them to the appropriate insurance company or to their employer when necessary for further benefit information or interpretation of policy.
• Interviews patient in person and / or on the telephone identifying problem or concern; Investigates and communicates action to patient in a timely and professional manner;
• Investigates and prepares appeals when claims are denied for no referral or pre-certification; Notifies health plan with appeal and notifies patient of appeal process and outcome.
• Works closely with BMC's insurance companies regarding effective / termination dates, PCP changes, and referral / no pre-authorization problems;

Researches source documents, including review of patient's medical chart, submits information necessary to resolve initial inquiry and receive payment.

• Must be knowledgeable about managed care insurance rules and regulations in order process referrals and pre-authorizations.
• Must be able to analyze detailed breakdowns of applicable managed care insurance coverage and use judgement and initiative in researching questionable charges and coverage.
• Must have accurate typing skills, strong computer knowledge and experience operating office machines such as printers and fax machines.
• Must possess basic math aptitude, professional manner, tact, pleasant telephone voice, ability to initiate correspondence using appropriate grammar, etc.

ability to communicate appropriate insurance policy rules to patients (for managed care plans).

Education Requirements :

• High school diploma.
• Some college courses and / or courses medical terminology, preferred.

Previous Experience :

• 0 -1 year experience working with managed care insurance rules and regulations or equivalent.
• Experience with ICD-9 coding highly desired.

The starting hourly pay range for this position is commensurate with experience :

$16.69 - $21.70 / hour (full pay range is $16.69 - $25.03)

This position will be posted for a minimum of three days, subsequently until filled.

Benefits :

BMC offers a comprehensive benefit package for full-time employees that includes medical / dental / vision, flexible spending, company-paid life insurance and STD as well as voluntary benefits, RTD EcoPass, 401(k), Paid Time Off and 6 paid holidays annually.

Part-time employees are eligible for medical / dental / vision, company-paid life insurance, voluntary benefits, RTD EcoPass, and 401(k).