Job Title

Referral Authorization Specialist

Reports To

The Referral Authorization Specialist position will report directly to the Administrative Manager.

Position Summary

Provides information on medication coverage, patient account status, and secures medical/clinical authorizations for services.

Responsibilities and Duties:

Secures medical/clinical authorizations for services.

• Obtain authorization via web/fax or phone.
• Document all pertinent communication with various parties not limited to pharmacy, physicians, health care facilities, insurance companies.
• Utilize clinical documentation and critical thinking to obtain authorization for all levels of patient care.
• Communicate with clinical staff on any issues as they arise, missing documentation, low medical necessity cases.
• Discuss insurance and authorization documents with patients.
• Appeal insurance companies after authorization refusal or denials.

Administrative Duties

• Updates/documents notes in excel team’s tracker with status and progress.
• Monitors the fax inbox/email/voicemails daily to ensure follow up completed in a timely manner.
• Assists in scheduling peer reviews in a timely manner to ensure continuous coverage.

Supervises, trains, orients assigned personnel.

Performs other job-related duties as assigned.

• Attends meetings as required.
• Adheres to HIPAA guidelines/regulations/annual HIPAA training.

Education

• A high school education or GED

Work Experience

• One to three years of similar or related experience.

Knowledge

• Sound knowledge of medical terminology and billing.

Skills/Abilities

• Excellent oral and written communication abilities.
• Good interpersonal and public relations skills.
• Solid problem-solving skills.
• Attention to detail.
• Well organized.
• Able to correctly operate all related medical equipment.

Physical Requirements

• Frequent sitting, standing, walking, grasping, carrying, and speaking; Occasional reaching, bending and stooping; Lifting, carrying, pushing and pulling up to 50 pounds, with assistance if needed; May need to lift or turn patients who are disabled, with assistance if needed; Frequent use of computer, keyboard, copier and phone.

Interpersonal Skills

• Courtesy, tact, and diplomacy are essential elements of the job. Work involves much personal contact with others inside and/or outside the organization for purposes of giving or obtaining information, building relationships, or soliciting cooperation.
• Adheres to HIPAA guidelines/regulations/annual HIPAA training.

Work Environment

• Environmentally controlled medical office environment: Work hours subject to office needs to ensure coverage during all hours of operation.

Benefits: Benefits Eligible

Benefits: Benefits Eligible

• For more information on UCF Health benefits including cost go to: https://ucfhealth.com/careers/