Lifepoint Health
Referral Authorization Specialist
Lifepoint Health, Las Cruces, New Mexico, United States, 88001
Referral Authorization Specialist
Memorial Medical Center is part of Lifepoint Health, a diversified healthcare delivery network with facilities coast to coast. We are driven by a profound commitment to prioritize your well-being so you can provide exceptional care to others. The Referral Authorization Specialist is responsible for ensuring that patients are getting the care that they need in a timely manner, on a daily basis, this will involve processing referrals in a complete, accurate, and timely manner, verifying that patients have received the care they require, and notifying providers if patients do not follow through with referrals. Essential Functions: Completes pre-authorizations for all diagnostic testing, therapy, surgical and specialty care appointments according to insurance requirements within 3 days of issuance. Notifies patient when referral is approved and notifies Provider if denied or if a second opinion or additional information is required. All communication with patient, nurse, and/or Provider will be documented in the clinic EMR. Updates to referrals will be made in the EMR each time communication is had with patient, insurance provider, nurse, or Provider. Maintains up-to-date knowledge of all health care plans and interprets and communicates plan policies and procedures to employees, physicians and (patients) when they have changed. Identifies and attempts to resolves patient's barriers to specialty care, including assisting with scheduling appointments and helping to coordinate with specialist offices. Assists in tracking high-priority referrals to ensure patients in high-risk categories receive necessary follow up care. Under the supervision of physician or nurse, assists with performing patient assessments and treatments. Performs administrative or clerical duties as assigned, including filing, reception, scheduling, data entry, and patient registration. Nonessential Functions: Perform other duties as assigned. Minimum Qualifications: High school diploma or equivalent is required. Two years of college preferred Skills & Experience: Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision. Must be able to work in a stressful environment and take appropriate action. Why join us: Comprehensive Benefits: Multiple levels of medical, dental and vision coverage for full-time and part-time employees. Financial Protection & PTO: Life, accident, critical illness, hospital indemnity insurance, short- and long-term disability, paid family leave and paid time off. Financial & Career Growth: Higher education and certification tuition assistance, loan assistance and 401(k) retirement package and company match. Employee Well-being: Mental, physical, and financial wellness programs (free gym memberships, virtual care appointments, mental health services and discount programs). Professional Development: Ongoing learning and career advancement opportunities. More about Memorial Medical Center: Memorial Medical Center is a 199 bed acute medical/surgical teaching hospital located in Las Cruces, NM, and is part of Lifepoint Health, a diversified healthcare delivery network committed to making communities healthier with acute care, rehabilitation, and behavioral health facilities from coast to coast. From your first day to your next career milestoneyour experience matters. Memorial Medical Center is an Equal Opportunity Employer. MMC is committed to Equal Employment Opportunity for all applicants and employees and complies with all applicable laws prohibiting discrimination and harassment in employment.
Memorial Medical Center is part of Lifepoint Health, a diversified healthcare delivery network with facilities coast to coast. We are driven by a profound commitment to prioritize your well-being so you can provide exceptional care to others. The Referral Authorization Specialist is responsible for ensuring that patients are getting the care that they need in a timely manner, on a daily basis, this will involve processing referrals in a complete, accurate, and timely manner, verifying that patients have received the care they require, and notifying providers if patients do not follow through with referrals. Essential Functions: Completes pre-authorizations for all diagnostic testing, therapy, surgical and specialty care appointments according to insurance requirements within 3 days of issuance. Notifies patient when referral is approved and notifies Provider if denied or if a second opinion or additional information is required. All communication with patient, nurse, and/or Provider will be documented in the clinic EMR. Updates to referrals will be made in the EMR each time communication is had with patient, insurance provider, nurse, or Provider. Maintains up-to-date knowledge of all health care plans and interprets and communicates plan policies and procedures to employees, physicians and (patients) when they have changed. Identifies and attempts to resolves patient's barriers to specialty care, including assisting with scheduling appointments and helping to coordinate with specialist offices. Assists in tracking high-priority referrals to ensure patients in high-risk categories receive necessary follow up care. Under the supervision of physician or nurse, assists with performing patient assessments and treatments. Performs administrative or clerical duties as assigned, including filing, reception, scheduling, data entry, and patient registration. Nonessential Functions: Perform other duties as assigned. Minimum Qualifications: High school diploma or equivalent is required. Two years of college preferred Skills & Experience: Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision. Must be able to work in a stressful environment and take appropriate action. Why join us: Comprehensive Benefits: Multiple levels of medical, dental and vision coverage for full-time and part-time employees. Financial Protection & PTO: Life, accident, critical illness, hospital indemnity insurance, short- and long-term disability, paid family leave and paid time off. Financial & Career Growth: Higher education and certification tuition assistance, loan assistance and 401(k) retirement package and company match. Employee Well-being: Mental, physical, and financial wellness programs (free gym memberships, virtual care appointments, mental health services and discount programs). Professional Development: Ongoing learning and career advancement opportunities. More about Memorial Medical Center: Memorial Medical Center is a 199 bed acute medical/surgical teaching hospital located in Las Cruces, NM, and is part of Lifepoint Health, a diversified healthcare delivery network committed to making communities healthier with acute care, rehabilitation, and behavioral health facilities from coast to coast. From your first day to your next career milestoneyour experience matters. Memorial Medical Center is an Equal Opportunity Employer. MMC is committed to Equal Employment Opportunity for all applicants and employees and complies with all applicable laws prohibiting discrimination and harassment in employment.