Referral Authorization Specialist

Referral Authorization Specialist

JPS Health Network is a $950 million, tax-supported healthcare system in North Texas. Licensed for 582 beds, the network features over 25 locations across Tarrant County, with John Peter Smith Hospital a Level I Trauma Center, Tarrant County's only psychiatric emergency center, and the largest hospital-based family medical residency program in the nation. The health network employs more than 7,200 people.

The Referral Authorization Specialist is responsible for verification of insurance benefits and eligibility prior to submitting for authorization and pre-certification requirements. This position is responsible for scheduling appointments per approved protocols and guidelines as well as assist callers in accessing services and providing general healthcare related information as needed.

Typical Duties:

1. Coordinates with medical staff, payers, physicians, and patients regarding authorization status and options.
2. Maintains current referral procedures according to payer requirements.
3. Oversees inbound, outbound calls and/or review correspondence, documents and other referrals received via fax or email.
4. Initiates, follows up, and verifies insurance eligibility and benefits for services ordered and documents complete information in Epic referral notes.
5. Obtains prior authorizations as required by payer, including procurement of needed clinical documentation by collaborating with Clinical Care Team and payer. Obtain all authorizations via web, fax or phone.
6. Assists patient with finding resources that accept various insurances, when processing Outgoing/External referrals.
7. Determines patient's financial responsibilities as indicated by payer.
8. Configures coordination of benefit information and eligibility on every referral.
9. Documents all pertinent communication with patient, physician, and payer.
10. Reviews and manages Epic work queues to maintain accurate and timely authorization requests.
11. Schedules appointments as appropriate within required timeframes.
12. Serves as a resource liaison with referral/appointment inquiries from patients, clinical care teams, and other staff.
13. Meets productivity and documentation standards while following planned priorities as set by Patient Access Team Lead and/or Manager.
14. Performs other related job duties as assigned.

Required Education and Experience:

• High School Diploma or GED equivalent.
• 1 plus years of progressive responsibilities and direct work related experience.
• 1 plus year of experience in a Patient Access/Patient Accounting role

Required Licensure/Certification/Specialized Training:

• Completion of 90 day and annual competency based registration knowledge and skills assessments.
• Patient Access General Consent Orientation and Patient Financial Experience Training (must be completed 30 days subsequent to hire)

Preferred Licensure/Certification/Specialized Training:

• Certified Healthcare Access Associate (CHAA)
• Bilingual in Spanish, Vietnamese, Arabic or other language.

Location Address: 1500 S. Main Street Fort Worth, Texas, 76104 United States