About the role
The referral & prior authorization specialist is responsible for ensuring the timeliness and accurate use of referrals by; monitoring appropriateness, medical necessity, and provides necessary information to obtain authorization.
The referral & prior authorization specialist is responsible for ensuring the timeliness and accurate use of referrals by; monitoring appropriateness, medical necessity, and provides necessary information to obtain authorization. Performs telephonic support for online authorization of routine services Provides direct support to Primary Care practices and specialty care providers regarding utilization, authorization, and referral activities Becomes proficient in the use of ICD-9/ICD-10 and CPT codes Contacts providers with authorization, denial, and appeals process information Assists in educating and acts as a resource to primary care practices andspecialty care providers in regards to prior authorization needs.
Verifies eligibility of members and participating status of providers Determines member benefit coverage Performs other duties as required Receive, track and obtain insurance authorization from in-network and out-of-network insurance carriers for New Patient and Follow-Up visits with our medical providers. Process physician referral orders (EMG, CT, MRI, etc.) using eCW (EMR system). This includes obtaining any insurance authorization needed.
Coordinate referrals for insurance plans that require authorization (work comp, etc). This includes obtaining any insurance authorization needed. Accurately enter notes into eCW regarding letters or correspondence from insurance companies regarding insurance authorization or other notifications.
These documents should also be scanned into the appropriate patients chart in eCW. Calling incoming referrals and scheduling office visits based on the referral Demonstrate and apply knowledge of medical terminology, high proficiency of general medical office procedures including HIPAA regulations. This is a per diem position.
About Our
Amazing people deserve amazing benefits. We strive to employ and retain the most highly qualified individuals by providing equitable wages and benefits, promoting from within, and supporting the continuing education efforts of our staff. You will be valued and rewarded for the work you do here with excellent pay and outstanding benefits.
At MCH, you’ll find great opportunities for career advancement as well as personal and professional growth. Per diem employees enjoy: Free membership to local gym Positive work environment with a supportive team and opportunities for growth Retirement savings plan Apply Now! or click the Apply button above About Monadnock Community Hospital: Reach new heights at Monadnock Community Hospital. MCH is a critical access hospital in beautiful, historic Peterborough, New Hampshire.
For 100 years, we have provided outstanding care to our communities, earning a reputation for excellence that has made us one of New Hampshire’s most successful and beloved small hospitals. Join a culture of Compassion, Collaboration, Honesty, and Respect! Our employees are the heart and soul of Monadnock Community Hospital.
In every department and at every level, MCH employees go above and beyond to deliver an exceptional patient experience in an atmosphere that is healthy, friendly, respectful, and personally fulfilling. About the Monadnock Region: A great place to live, work, and play. One of the best things about working at Monadnock Community Hospital is that you get to live in a community that offers an amazing quality of life.
The state of New Hampshire consistently ranks in the Top Ten of all American states for its overall quality of life. Towns are small and friendly here, crime is low, schools are good, and the air and water are clean. Balance meaningful work with a great life.
Here in the Monadnock Region, you can enjoy a standard of living that is hard to match anywhere. Let’s start with our mountain for which we are named. Around the 3,165 foot Mount Monadnock with 100-mile views are forests, woods, lakes, and protected rivers providing abundant opportunities for hiking, biking, kayaking, fishing, cross-country skiing – you name it!
And if you’re into the arts, the region also offers a lively arts scene, with galleries, theatres, and concert venues. New England community spirit Family-friendly Arts and culture All-season outdoor recreation Just 1.5 hours to Boston Are you ready for a great job in a great place? Are you ready for a career the supports your aspirations?
Are you ready to work in the best place you've ever lived? Apply Now! or click the Apply button above Our small hospital is committed to diversity, inclusion, and equal opportunity employment. We welcome applications from individuals of all backgrounds and abilities.
We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, disability status, veteran status, or any other characteristic protected by law. Education High School (required) Experience Exceptional customer service (required) Prior experience with referrals, calling patients and scheduling appointments from referrals (preferred) Excellent computer, multi-tasking and phone skills.
(required) At least one year of pre-cert experience, including navigating websites for online benefit reviews. (required)