Job DetailsJob LocationBMH Hill Building - Madison, WVPosition TypeFull TimeDescriptionSummary The Prior Authorization Specialist is responsible for sustaining an effective support structure by managing administrative and clerical tasks of Boone Memorial Hospital, Inc.'s ( BMH ) Referral Department. The Prior Authorization Specialist is responsible for receiving, processing, scheduling, and following up on all medical referral requests; including but not limitedto, in-house and outside referrals for diagnostic testing, medical specialists, or other providers. The Prior Authorization Specialist will coordinate and organize appointments and documentation to facilitate the smooth running of the healthcare environment and support delivery of quality patient care. Essential FunctionsReasonable accommodations may be made to enable individuals with disabilities to perform these essential functions.The Prior Authorization Specialist is expected to perform the following essential functions:
- Maintains a good rapport with co-workers and healthcare providers
- Fosters communication between multiple disciplines on the behalf of patients
- Interacts professionally with co-workers and healthcare providers
- Participates in informal conferences involving the care of patients
- Answers the telephone, emails, and faxes in a timely and efficient manner
- Treats patients and their families with respect and dignity
- Completes and processes patient referrals in a timely and efficient manner
- Maintains a tracking log of all patient referrals
- Runs reports or views patient logs to be aware of all patient referrals
- Follows up on referrals for accuracy and completeness
- Completes all forms for required for patient referrals
- Shares patient data with the referring specialist in a professional/ efficient manner
- Enters patient information correctly into the computer and or other logs as required
- Processes all referrals in a timely manner. Ensures that all referrals are managed promptly with all documentation, coding, and physician's notes and recommendations, to ensure the referral is complete
- Demonstrates skilled knowledge of computer systems in order to perform the job effectively
- Documents all patient referral information where required (in CPSI/Medical Records)
- Knowledge of ICD-10 and CPT coding practices. Maintains up to date knowledge of changes of ICD-10 coding
- Maintains patient confidentiality and abides by all HIPAA rules and regulations
- Maintains regulatory requirements
- Complies with all organizational policies regarding ethical business practices
Required Skills, Qualifications, and Competencies
- Excellent verbal and written communication skills
- Excellent interpersonal and customer service skills
- Excellent organizational skills and attention to detail
- Excellent time management skills
- Strong analytical and problem-solving skills
- Ability to prioritize tasks and to delegate them when appropriate
- Proficient with Microsoft Office Suite or related software
Supervisory Responsibilities
Physical demands
- Prolonged periods of sitting at a desk and working on a computer
- Must be able to lift up to 25 pounds at times
Travel required
Required education and experience
- High School Diploma or equivalent
Preferred education and experience
- Associate degree in Medical Office Administration (preferred)
- 1 or more year(s) of experience in healthcare or related field
- Knowledge of ICD-9 and CPT codes
Other DutiesPlease note this job description is not designed to cover or contain a comprehensive listing of all activities, duties, or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time. Equal Employment Opportunity Policy Statement Boone Memorial Hospital, Inc. provides equal employment opportunities to all personnel and applicants for employment and prohibits discrimination, harassment, prejudice, or behavior of any type based on race, color, religion, age, sex (including pregnancy), national origin, disability status, family medical history or genetic information, past or present military service, sexual orientation, gender identity or expression, family or parental status, political affiliation, or any other characteristic protected by federal, state or local laws.