Authorization Rep

Authorization Rep USA Remote Shift: Day 5x8-Hour (09:00 - 17:00)100% Remote Note: MUST be legally authorized to work in the United States. SUMMARY:Processes referral requests for patients to achieve timely and accurate determinations. Works within scope of practice to complete or forward requests as appropriate to Managed Care physicians and/or nurses as per the Utilization Management (UM) protocols. Maintains required turnaround times for referral completion. Assists providers and patients with referral status questions. Participates in development and implementation of improvements to the referral process and workflows. JOB ACCOUNTABILITIES:Processes referrals per standard work and refer others to nurses and/or MDs as necessaryMaintains accuracy with attention to detail in each referralMonitors daily "pending" referrals to ensure timeliness standards are met and customer service is maximizedReports anticipated problems to Supervisor and/or other stakeholdersDocuments updated status in referrals per standard workProvides necessary medical information to obtain final determinations when requiredProcesses referrals per health plan contracts and requirementsDocuments determinations in referral as per standard work JOB QUALIFICATIONS: Education: HS Diploma or equivalent education/experience Skills and Knowledge: Medical terminology, Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS)/International Classification of Diseases (ICD)-9 coding knowledgeCompetency in using MS Office Excel and Word, other Managed Care programsAbility to identify, understand and solve problems related to claims and referralsCommunication skills, including understanding of medical concepts, ability to organize thoughts, and communicate issues concisely and effectivelyProven ability to quickly adjust to changing projects and priorities and to multi-taskOrganizational skills We are an equal opportunity employer, and we are an organization that values diversity. We welcome applications from all qualified candidates, including minorities and persons with disabilities. req3331618