医师授权/转诊专员 I
Physician Authorization/Referral Specialist I
加入我们的团队，担任医师授权/转诊专员，你将在确保患者获得及时、协调护理方面发挥关键作用。
申请人必须居住在三州地区：宾夕法尼亚州、新泽西州、马里兰州或特拉华州。
该职位负责获取和处理各种门诊服务的择期、紧急和急诊转诊及授权，包括心脏病学、听力学、实验室检测、基因检测和某些药物。他们核实保险资格和福利，计算并传达患者的费用预估，并在服务发生前完成自付额要求和审批。
此职位与保险公司、初级保健医生、合作医院和内部部门密切合作，以确保信息准确、及时处理索赔，并提供无缝的患者支持。该专员使用每日报告和工作队列跟进待办案件，参与部门例会，并协助解决可能影响报销的问题。他们还需提供优质的客户服务，支持医疗补助注册流程，有效使用EPIC系统，并协助培训新团队成员。
职责：
1. 确保根据部门政策和付款方要求，及时通知和请求授权/转诊。
2. 保持机密性，核实患者人口统计信息、保险资格、福利和财务责任。
3. 能够为指定专科请求/获取授权/转诊，并能覆盖大多数专科。
4. 能够在书面和口头沟通中有效、及时且专业地交流。
5. 亲自或通过电话联系家庭，获取必要信息并帮助他们解决可能阻碍授权/转诊的保险问题。
6. 在标准化文档要求中清晰记录与付款方和家庭的所有沟通和联系，包括正确的格式。
7. 一贯表现出优秀的、富有同理心且专业的客户服务技能，面向内部和外部客户。
8. 了解并遵守所有州和联邦法规，包括但不限于EMTALA、HIPAA和联合委员会的规定。
9. 能够审查流程并在专科领域提出改进建议。
10. 能够独立工作，优先安排任务，并在需要时协助其他同事。
11. 建立并维护专业、协作的工作关系
查看英文原文
Join our team as a Physician Authorization/Referral Specialist, where you’ll play a vital role in ensuring patients receive timely, coordinated care.
Applicants must reside in the tristate area: Pennsylvania, New Jersey, Maryland or Delaware.
The Specialist is responsible for obtaining and processing elective, urgent, and emergent referrals and authorizations for a wide range of outpatient services, including cardiology, audiology, lab testing, genetic testing, and certain medications. They verify insurance eligibility and benefits, calculate and communicate patient cost estimates, and ensure copay requirements and approvals are completed before services occur.
This role works closely with insurance companies, primary care providers, partner hospitals, and internal departments to ensure accurate information, timely claim processing, and seamless patient support. The Specialist uses daily reports and work queues to follow up on pending cases, participates in department huddles, and helps resolve issues that could affect reimbursement. They are also expected to deliver excellent customer service, support Medicaid enrollment processes, use EPIC effectively, and assist with training new team members.
Responsibilities:
1.Ensure timely notification and request for authorization/referrals is handled in accordance with departmental policy and payor requirements.
2. Maintaining confidentiality, verify patient demographics, insurance eligibility, benefits, and financial responsibility.
3. Ability of request/obtain authorizations/referrals for assigned specialties and be able to cover for most specialties.
4. Communicate effectively, timely and professionally in writing and verbally
5. Contact and interview families in person or by phone contact to obtain necessary information and assist them with insurance issues that may be preventing authorization/referrals.
6. Clearly document all communications and contacts with payors and families in standardized documentation requirements including proper format
7. Consistently demonstrates excellent, empathetic and knowledgeable customer service skills to internal and external customers
8. Is aware and adheres to all State and Federal Regulations including, but not limited to: EMTALA, HIPAA, and the Joint Commission
9. Ability to review workflows and suggest improvements in specialty areas
10. Ability to work independently, prioritize workload and assist other associates as required.
11. Build and maintain professional, cooperative relationships with all departments that have direct or indirect impact on obtaining authorizations.
12. Prepare estimates for scheduled services. Must interpret patient’s benefits correctly for accurate estimates.
13. Work with partner hospitals for claim submission and registration accuracy.
Qualifications:
- Referral/authorization work experience required (minimum one year experience)
- High School diploma required
- Required to reside: Pennsylvania, Maryland, New Jersey or Delaware.
Originally posted on Himalayas