Referral & Prior Authorization Specialist - REMOTECommunity Health Program Inc • Great Barrington, MA, US

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Referral & Prior Authorization Specialist - REMOTE

Community Health Program Inc • Great Barrington, MA, US

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Job Description

ABOUT THE ORGANIZATION

Community Health Programs is a network of health centers and caring professionals that provide outstanding primary and preventive care for patients of all ages. What's truly unique to CHP is our broad spectrum of support services that extend beyond medical and dental issues to strengthen families and improve children's well-being. The region is a federally designated rural community and a Medically Underserved Population Area.

Community Health Programs embraces its role as a nonprofit health care provider and community partner. We are a leader in the communities we serve by providing high quality healthcare, dental services, wellness education and family support services. CHP outreach provides free health screenings, insurance enrollment assistance as well as information so people can learn how to take better care of themselves and their families.

Salary Range : $18.00 - $21.00 / hour The Referral and Prior Authorization Specialist coordinates patient care assistance services with various external organizations; manages referrals to specialty providers, surgical and imaging prior authorizations as directed by the primary care providers in the health center including appointment arrangements, which may include notification to a referral resource that an interpreter is needed. Manages relationship between patient and health center with various insurance companies to ensuring compliance with authorization requirements; overseeing electronic referral system in the EMR; performs other administrative duties as requested. This person will support CHP’s mission, vision, and values and will adhere to compliance protocols as well as CHP’s policies and procedures.

POSITION REQUIREMENTS

Referral Specialist Essential Duties and Responsibilities :

Coordinates all outgoing / incoming referrals and prior authorizations :

Maintains the computerized managed care system and maintains electronic referrals in EMR.

Coordinates all referral and documents this information on the referral request form and practice management system and notifies patient of same.

Efficiently obtain all prior authorizations for procedures, tests, or services to be performed based on a provider’s order and prior to the patient’s next scheduled date of service.

Collaborates with the primary care provider and other clinical staff to resolve issues related to specialist availability and patient needs.

Scans all completed referral forms into the patient’s chart.

Maintains a system for easy access to authorization numbers, number of visits and utilization.

Completes follow-up with hospitals about submitting orders and any other related documentation (financial or clinical).

Updates status of referral in EMR as there is new information.

Follows up in appropriate buckets to obtain information to close out referral.

Functions as a resource of information and problem solving for patients, primary care providers managed care program staff, specialists, and health center staff.

Maintains up-to-date knowledge of insurance company requirements.

Assists with development and presentation of managed care reporting to Practice Managers on monthly basis, including but not limited to, indicating numbers of referrals, turnaround time for booking referrals and utilization.

Attends appropriate meetings to maintain up to date knowledge of Health Center activities; if unable to attend meetings, contacts supervisor for information.

Attends appropriate various external organizational meetings with insurance companies and hospitals.

Participates in HRSA activities.

Maintains documentation to meet audit requirements and participates in audit activities as requested.

Performs other duties as directed.

Competencies : To perform the job successfully, an individual should demonstrate the following competencies :

Positive attitude.

Work independently.

Exercise creativity and good judgement.

Attentive to detail.

Maintain multiple and simultaneous responsibilities.

Prioritize duties / tasks.

Excellent customer service and communication.

Essential Skills and Qualifications : To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and / or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

College graduate preferred.

Must have previous experience in health care setting.

Detail-oriented with strong communication and organizational skills.

Familiarity with managed care plans and computer skills preferred.

Team oriented; strong commitment to helping others.

Bilingual in Spanish preferred.

Physical Requirements :

Click here to view the Administrative ADA requirements.

FULL-TIME / PART-TIME Full-Time

POSITION Referral & Prior Authorization Specialist

EXEMPT / NON-EXEMPT Non-Exempt

LOCATION MA, Great Barrington, Berkshire County

EOE STATEMENT

We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status or any other characteristic protected by law.

PIf38d07c16e02-25405-38836304

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Prior Authorization Specialist • Great Barrington, MA, US