Job Posting
Referral/Pre-Authorization Clerk
CCMH has an opening for a full-time Referral/Pre-Authorization Clerk. Duties and responsibilities for this position will include 1.) Coordinate the referral and pre-authorization review process for scheduled visits and outpatient services. 2.) Demonstrate accurate, thorough and efficient review of pre-authorization requests. 3.) Secure pre-certifications by developing and maintaining effective relationships with managed care representatives, physicians, and medical staff members. 4.) Effectively and professionally communicate clinical information that the insurance carriers need and answer pertinent questions to get referrals and pre-authorization processed efficiently and timely. 5.) Develop and maintain effective relationships with all ancillary departments (Radiology, OR, Lab, Specialty, etc.) 6.) Perform regular and routine communication as needed to ensure results are reported accurately and timely. 7.) Assist scheduling and registration with appropriate ICD-10 codes and verbal orders using on and off-site medical coders as a resource when necessary. 8.) Assist with coordinating and timely scheduling of authorized outpatient procedures when pre-authorizations have been obtained. 9.) Provide timely feedback and follow-through of responses to staff, including any issues and obstacles, from insurance companies regarding referrals and pre-authorizations so appropriate actions can be taken, and patient services are not delayed. 10.) Establish and maintain long-term, positive customer relationships, building trust and respect
Required Qualifications/Skills/Abilities:
Ability to: 1) evaluate medical records and other health care data; 2) exercise good judgement and tact in relating to health care providers and insurance representatives; 3) effectively prioritize multiple tasks and deadlines to complete assignments within acceptable timeframes, always keeping patient care and needs in the forefront; demonstrate thorough understanding of medical and insurance terminology. 4.) 2-3 years’ experience (on-the-job training) processing required medical referrals and pre-authorizations. 5) Ability to effectively maneuver through EMR systems to effectively finalize referrals and pre-authorizations timely and accurately.
Physical Requirements:
The ability to sit for 4-6 hours per day while operating a video display terminal and phone system; walking for 2 or more hours per day. 2) Work under sometimes high-pressure situations. 3) Light to moderately high workload; ability to lift and carry up to 50 lbs., with or without assistance. 4) Position requires reaching, bending, stooping, lifting and handling objects with hands and/or fingers, talking, hearing and seeing within normal expectations.
Must have excellent communication skills and follow-through abilities. CCMH boasts a highly competitive wage and benefit package. We take pride in providing a safe, healthy, and positive work environment! Qualified candidates may apply for this position by visiting our website and clicking on “careers”.
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Contact Information: Human Resources: Cindy.Schreiber@cedarcomem.com
Contact Information
Terra Hackett - Business Manager
Business office
Email: terra.hackett@cedarcomem.com |
