Referral/Prior Authorization Specialist

CHANGEPOINT INTEGRATED HEALTH JOB DESCRIPTION TITLE

SHOW

LOW MEDICAL - REFERRAL/PRIOR AUTHORIZATION SPECIALIST STATUS

NON-EXEMPT

LINES OF AUTHORITY

This position is supervised by the Show Low Medical Office Manager.

POSITION SUMMARY

The Show Low Medical Referral/Prior Authorization Specialist works with the medical staff to coordinate patient referrals and medication prior authorizations for medical and psychiatric services provided at ChangePoint Integrated Health. This position also provides a variety of clerical and general office support duties to facilitate operations of the department and care of patients.

PRINCIPLE DUTIES/RESPONSIBILITIES

1. Adhere to personnel policy and comply with agency requirements for ethical and professional behavior. 2. Coordinates referrals to external medical providers. 3. Obtains authorizations from various insurance companies according to their plan requirements. 4. Communicates status of referrals to patient. 5. Tracking and following up to close the loop making sure patients have seen referred provider and records are received.6. Obtains medication prior authorizations for both psychiatric and medical services provided. 7. Communicates status of prior authorization to patient. 8. Scanning and indexing documents into patient charts. 9. Answer telephones on a daily basis. 10. Provides back up for clerical staff as needed. 11. Must participate in meetings as required. 12. This position requires positive and active support of the company, thecustomer and the co-worker. 13. Performs other duties as assigned by the Office Manager.

PRIMARY CONTACTS

Frequent interaction with customers and administrative personnel.

POSITION REQUISITES

Qualifications and Experience Required:

High School Diploma/GED. Valid Arizona Driver's License. Fingerprint Clearance. Comply with a Drug Free Workplace. Two Years' Experience in Data Entry - preferred.

Skills/Abilities Required:

Fluent in English both verbally and in writing. Literate. Able to prioritize own workload. Able to effectively employ analytical and problem-solving skills. Able to type accurately; perform numeric calculations; computer skills. Phone courtesy and customer service skills.

Preferred:

Effective time management skills. Able to work forty (40) hours per week.

WORKING CONDITIONS

Physical Requirements Sitting for extended periods of time at a desk/computer; less frequently, walking, lifting and reaching. Visual capacity necessary to fulfill documentation, responsibilities of job. Able to hear ordinary conversation and phone communications. Equipment Operation Able to correctly use office equipment (e.g.: calculator, copier, PC/word processor, fax) and trouble shoot common office equipment problems. Able to employ multi-line telephone system. Environmental Conditions Air conditioned and/or heated office setting. Accommodation(s) Will accommodate as appropriate and reasonable.

CONFIDENTIALITY LEVEL

I understand that State and Federal Laws strictly prohibit unauthorized access, use, modification, disclosure, or destruction of confidential, sensitive or protected health information. Penalties for violation may include ChangePoint disciplinary action, including termination of employment, and/or criminal or civil action.