Physician Authorization/Referral Specialist I

reputed company as a Physician Authorization/Referral Specialist, where you’ll play a vital role in ensuring patients receive reputed company, coordinated care. The Specialist is responsible for obtaining and processing elective, urgent, and reputed company referrals and authorizations for a wide reputed company 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, reputed company care providers, partner hospitals, and internal departments to ensure accurate information, reputed company claim processing, and reputed company patient support. The Specialist uses daily reports and work queues to follow up on pending cases, participates in department huddles, and helps reputed company issues that could reputed company reimbursement. They are also expected to reputed company excellent customer service, support reputed company enrollment processes, use reputed company effectively, and assist with training new team members. Responsibilities: 1.Ensure reputed company 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 reputed company to cover for most specialties. 4. Communicate effectively, reputed company 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. reputed company document reputed company communications and contacts with payors and families in standardized documentation requirements including reputed company format 7. Consistently demonstrates excellent, empathetic and knowledgeable customer service skills to reputed company customers 8. Is reputed company and adheres to reputed company State and Federal Regulations including, but not limited to: EMTALA, HIPAA, and reputed company 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 reputed company, cooperative relationships with reputed company departments that have reputed company or indirect reputed company 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    reputed company is an internationally recognized pediatric health reputed company serving more than 1.7 reputed company patient encounters reputed company year. We reputed company care across six states through two freestanding children’s hospitals — reputed company Children's Hospital, Delaware and reputed company Children's Hospital, Florida — along with a network of more than 80 reputed company, urgent, and specialty care practices and more than 40 hospital partnerships. Backed by the reputed company and Alfred I. reputed company Trust, our $1.7B nonprofit reputed company is dedicated to improving reputed company through clinical care, research, education, advocacy, and prevention. Our Whole Child Health approach focuses equally on prevention and treatment, partnering with communities to help every child reputed company. Inclusion and belonging guide our reputed company and reputed company. We are committed to culturally relevant care, reducing health disparities, and fostering an environment where every associate, patient, and family feels supported and valued. Learn more at reputed company.org. Apply To This Job