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For Companies At a Glance
- Tasks: Manage insurance referrals and authorizations to ensure smooth patient care.
- Company: Join a leading healthcare organisation focused on financial health and patient experience.
- Benefits: Enjoy competitive pay, flexible hours, and opportunities for professional growth.
- Why this job: Make a real impact on patient care while developing valuable skills in healthcare operations.
- Qualifications: High School diploma required; healthcare experience preferred, especially in insurance processing.
- Other info: Ideal for detail-oriented individuals who thrive in a fast-paced environment.
The predicted salary is between 28800 - 43200 £ per year.
The Referral and Authorization Specialist plays a vital and strategic role in supporting the financial health of the organization by overseeing the referral and authorizations processes for specialty visits and outpatient testing. This position is essential in centralizing and streamlining the authorization workflow, which is integral to the success of the organization's operations, patient experience, and financial performance. Obtaining timely and accurate authorization information, prior to performing services, reduces claim denials, ensures payer compliance, and establishes better organizational financial outcomes. This position is crucial to the organization's financial success and the delivery of a positive provider and patient experience, as their timely and accurate processing of referrals and authorizations ensures that patients receive the necessary care without delays, while also optimizing reimbursement.
Duties and Responsibilities:
- Request and obtain insurance referral and prior authorizations via the insurance carrier and/or third-party authorization companies and then track the status within CNE's EHR.
- Evaluate payer policies to understand authorization and notice of admission policies.
- Communicate the request/status of the insurance referral and/or prior authorization with internal referring provider offices/departments via the EHR.
- Utilize CNE's EHR to document all work related to obtaining and/or verifying insurance referral and prior authorizations.
- Work with both internal and external referring provider offices/departments to obtain the necessary information to obtain and/or verify the approval of the insurance referral or prior authorization.
- Verify the accuracy of the patient's insurance information to obtain the insurance referral or prior authorization.
- Communicate via the EHR any issues related to processing the referral (i.e., PCP not updated with the payer, provider documentation not complete) and/or the accuracy of the patient's insurance information to the referring department.
- Communicate any issues related to obtaining and/or verifying the approval of the insurance referral and/or prior authorization to management.
- Manage the start of the external referral process for all CNEMG PCPs, to include submitting referrals, obtaining an approved insurance authorization, and sending all relevant clinical documentation to the external provider.
- Explain the Notice of Non-Covered Service Waiver and Notice of Non-Approved Prior Authorization waiver to patients.
- Work and monitor EHR WQ's and in Basket pools through the workday.
- Perform other duties as assigned.
Requirements:
- High School or GED is required, Associate degree or Certified/Registered Medical Assistance preferred.
- 5-7 years of experience working in healthcare.
- 3 years of experience processing insurance referral and/or prior authorizations.
Referral and Authorization Specialist employer: Care New England Health System
Contact Detail:
Care New England Health System Recruiting Team
StudySmarter Expert Advice 🤫
We think this is how you could land Referral and Authorization Specialist
✨Tip Number 1
Familiarise yourself with the specific insurance policies and procedures relevant to referrals and authorisations. Understanding the nuances of different payers can give you an edge in discussions and demonstrate your expertise during interviews.
✨Tip Number 2
Network with professionals already working in similar roles or within the healthcare industry. Attend relevant workshops or webinars to connect with others, as personal recommendations can often lead to job opportunities.
✨Tip Number 3
Gain hands-on experience with Electronic Health Records (EHR) systems, particularly those used for tracking referrals and authorisations. Being proficient in these systems will not only boost your confidence but also make you a more attractive candidate.
✨Tip Number 4
Prepare to discuss real-life scenarios where you've successfully navigated complex referral processes or resolved issues with authorisations. This will showcase your problem-solving skills and ability to handle the responsibilities outlined in the job description.
We think you need these skills to ace Referral and Authorization Specialist
Some tips for your application 🫡
Understand the Role: Before applying, make sure you fully understand the responsibilities of a Referral and Authorization Specialist. Familiarise yourself with the key duties mentioned in the job description, such as processing referrals and authorizations, and how they impact patient care and financial outcomes.
Tailor Your CV: Customise your CV to highlight relevant experience in healthcare and specifically in processing insurance referrals and prior authorizations. Emphasise any roles where you've managed similar tasks or worked with EHR systems, as this will demonstrate your suitability for the position.
Craft a Compelling Cover Letter: Write a cover letter that addresses why you're interested in the role and how your background aligns with the requirements. Mention specific experiences that showcase your ability to handle the responsibilities outlined in the job description, such as communication with providers and managing authorisation workflows.
Proofread Your Application: Before submitting your application, carefully proofread all documents for spelling and grammatical errors. A polished application reflects attention to detail, which is crucial for the role of a Referral and Authorization Specialist.
How to prepare for a job interview at Care New England Health System
✨Know Your Stuff
Make sure you understand the referral and authorization processes thoroughly. Familiarise yourself with common insurance policies and the specific requirements for authorisations. This knowledge will help you answer questions confidently and demonstrate your expertise.
✨Showcase Your Communication Skills
As a Referral and Authorization Specialist, you'll need to communicate effectively with various stakeholders. Prepare examples of how you've successfully communicated complex information in the past, whether to patients or internal teams, to highlight your ability to convey important details clearly.
✨Demonstrate Problem-Solving Abilities
Be ready to discuss situations where you've encountered challenges in obtaining authorisations or referrals. Highlight your problem-solving skills by explaining how you navigated these issues and what steps you took to resolve them efficiently.
✨Familiarise Yourself with EHR Systems
Since the role involves using an Electronic Health Record (EHR) system, it’s beneficial to have a basic understanding of how these systems work. If you have experience with specific EHR software, be sure to mention it during the interview to show your readiness for the role.
