Referral Specialist

MSA Orthopedics, a thriving orthopedic medical and surgical facility, is searching for a Referral Specialistin Albany, Georgia. The Referral Specialistwill join an established team with a long history of providing state-of-the-art care to our community. To perform this job successfully, the individual will be responsible for ensuring timely receipt of authorizations for all insurance patient referrals for incoming and outgoing referrals where required.

Skills and abilities required:

• Ability to learn practice management software on computer system
• Ability to use the internet actively for authorization process
• Good communication skills with physicians, therapists, patients, and third party payors
• Ability to follow practice protocol as directed
• Knowledge of insurance, data entry and medical terminology

Duties will include:

• Obtain authorizations for all outgoing and incoming patient referrals for office visits, imaging services, EMG/NCV, office procedures, injections, physical therapy treatments, DME products, and any other services that require prior authorizations via the internet, fax or telephone. Document in referral and in billing info on appointment.
• Verify benefits with the patient’s insurance and calculate patient responsibility. Notify patient of their responsibility prior to appointment. Document in referral and in billing info on appointment.
• Retrieve clinical information and dictation from patient’s medical record in an effort to expedite the authorization process.
• Document and enter insurance authorizations when obtained.
• Enter all authorized valid dates, numbers assigned by the insurance carrier, contacts and any other pertinent information obtained.
• Communicate denials and or approval authorization information to the appropriate nursing staff and therapists.
• Effectively communicate with the appropriate nurse and/or therapist when requesting the submittal for authorization.
• Ensure that all patient demographic information is accurate in computer system when obtaining and requesting the authorization.
• Determine if injections or medications are ordered through a specialty pharmacy as required by managed care payor.
• Consistently stay in contact with all medical staff regarding authorizations.
• Schedule all outgoing referrals within 24-48 hours. This includes filing out referral forms as required by the provider and faxing medical records.
• Back up physical therapy front desk person with checking in/out patients and answering phone calls.

Qualified applicants will possess the following:

• High school diploma or equivalent
• 1 to 2 years experience working with medical authorizations or referrals (preferred).
• Knowledge of insurance guidelines including HMO/PPO, Medicare, Medicaid, and other payer requirements and systems
• Ability to work independently and maintain confidentiality at all times
• Must be able to use job-related software, ie eClinicalWorks
• Maintain a positive, courteous and professional attitude

Compensation & Benefits:

Commensurate with experience.

MSA Orthopedics offers a generous and competitive benefits package including the following:

• Health insurance
• Paid time off
• 401(k) / 401(k) matching
• Dental Insurance
• Vision insurance
• Life insurance
• STD insurance
• LTD insurance
• Critical Illness Insurance
• Accidental Insurance
• Gym Membership

Selection Process:

MSA Orthopedics is an equal-opportunity employer. All applicants will receive consideration for employment regardless of race, color, religion, sex, national origin, ancestry, physical or mental disability, medical condition, marital status, age, veteran status, or sexual orientation.

Job Type: Full-time

Pay: From $17.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee discount
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Weekly day range:

• Monday to Friday

Work Location: In person