26 days old

Physician Auth/Referral Spec - Remote

Wilmington, DE 19801 Work Remotely
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The Physician Referral/Authorization Specialist is responsible for obtaining and processing Elective, Urgent, and Emergent referrals and authorizations for physician based services and some office based services, including but not limited to cardiology and audiology tests. The Physician Referral/Authorization Specialist is also responsible researching and notifying family of co-payment responsibilities. Referrals and authorizations are obtained prior to the date of service as per department standards. During the referral process the Physician Referral/Authorization Specialist will partner with the Primary Care Practitioner to obtained required referrals. During the authorization and notification process the Specialist will provide the payor with all patient information and requested documentation necessary to obtain admission approval.

This is a remote position for candidates residing in Delaware, Pennsylvania, Maryland and New Jersey.

Essential Functions:

  • This role is required to utilize all available resources to verify eligibility, benefit levels, and patient copayment responsibilities.
  • This position collaborates with: Hospital Authorization department, non Nemours physician offices, managed care department and Nemours Physicians, and Departmental Administrative Staff to ensure that accurate information is collected and distributed effectively and efficiently.
  • The Specialist utilizes daily reports and work queues to complete follow up on non-approved cases and assure completion prior to admission date according to department standards.
  • In addition, the Specialist will attend daily departmental huddles to report on payor issues, barriers impacting workflows, and specific issues that could result in a non-reimbursable visit.
  • The Specialist Physician Referral/Authorization is required to provide excellent, customer focused and efficient service to both internal and external customers and represent Nemours in a positive, professional manner.
  • In addition to the Physician Referral/Authorization Specialist I responsibilities, the Specialist will have the ability to cover all referral and most authorization visit types, participate in organizational committees/task forces, attend payor meetings and demonstrate effective utilization of EPIC applications as indicated by performance measures.
  • This position will also assist with new associate training and provide guidance around their specialty to other associates.

  • Minimum of one year referral/authorization experience required
  • High School Diploma required
  • Expert knowledge of insurance vendor websites
  • EPIC experience a plus

Schedule : Monday through Friday, 8:30 am to 5:00 pm.

Jobs Rated Reports for Physician

Posted: 2021-12-26 Expires: 2022-01-24
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Physician Auth/Referral Spec - Remote

Wilmington, DE 19801

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102nd2019 - Physician
Overall Rating: 102/199
Median Salary: $211,780

Work Environment
Very Poor
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