Authorization & Referral Associate - US Healthcare

Authorization & Referral Associate

Summary

GM Analytics Solutions is looking for a driven, dedicated and experienced Authorization & Referral Associate, who is experienced in the medical billing domain,.

Authorization Analyst is articulate professionals who can communicate with insurance companies and other payers in regards to unpaid claims and assist with actions and information needed to properly review, dispute, or appeal denial until a determination is made to conclude the appeal. Who should be proficient in US healthcare, and is comfortable working in Night shift (US time).

Job Description

• Minimum 1-3 years experience is required in Authorization & Referral process for US
  Healthcare & should have knowledge in Commercial & Workers Compensation Insurance.
• Who can receive medication referrals and collects insurance information via multiple
  methods, runs test claims, and Completes administrative duties.
• Work in teams that process Authorization & Referral transaction which strive to achieve team
  goal.
• Can review clinical documents for prior authorization/pre-determination submission
  purposes.
• Who can contact referral source, patient, and/or doctors office to obtain additional
  information that is required to Complete verification of benefits or prior approvals.
• Can perform outbound calls to patients or doctor offices to notify of any delays due to more
  information needed to Process or due to prior authorization.
• Provides exceptional customer service to external and internal customers, resolving any
  customer requests in A timely and accurate manner.
• Ensures the appropriate notification of patients in regard to their financial responsibility,
  benefit coverage, And payer authorization for services to be provided.
• Maintains prior authorizations and verifies insurance coverage for ongoing services.
• Completes all required duties, projects, and reports in a timely fashion on a daily, weekly, or
  monthly basis per The direction of the leadership.
• Collect, analyze, and record all required demographic, insurance/financial, and clinical data
  necessary to verify Patient information.
• Refer patients to Financial Counselors as needed to finalize payment for services.
• Document financial and pre-certification information according to a defined process on time.
• Request and coordinate financial verification and pre-certification as required to proceed with
  patient care; Document financial and pre-certification information according to defined
  process.
• Good Knowledge and understanding of Human Anatomy.
• Proficiency in Microsoft office tools
• Willingness to work the night shift

Education/ Experience Requirements:

• Should be a Graduate from any stream.
• Should possess excellent communication & written skills.
• Quick and eager to learn and mold accordingly to the process needs.
• Should have knowledge in Medical Terminology, knowledge of the different types of health insurance plans; i.e. HMO s, PPOs, etc.
• Ability to effectively handle multiple priorities within a changing environment.
• Experience in diagnosing, Isolating, and resolving complex issues and recommending and implementing Strategies to resolve problems.
• Ability to coordinate with US counterpart either by phone or by email.
• Ability to multi-task and organizational timely follow up.
• Ability to follow established work schedule.
• Excellent Analytical Skills.
• Should have advanced computer knowledge in MS Office Suite, pMD soft, Acumen, Athena Health, and other applications/systems preferred.

Salary BOE

GM Analytics Solutions is an equal opportunity employer and considers qualified applicants for employment without regard to race, color, creed, religion, national origin, sex, sexual orientation, gender identity and expression, age, disability, veteran status, or any other protected factor.

Competency Requirements:

Must possess the following knowledge, skills & abilities to perform this job successfully:

• Broad understanding of clinical operations, front office, insurance and authorizations
• Ability to communicate effectively and clearly with all internal and external customers
• Detail-oriented with excellent follow-up.
• Solutions-minded, compliance-minded and results-oriented.
• Excellent planning skills with the ability to define, analyze and resolve issues quickly and accurately
• Ability to juggle multiple priorities successfully.
• Extremely strong organizational and communication skills.
• High-energy, a hands-on employee who thrives in a fast-paced work environment.
• Familiar with standard concepts, practices, and procedures within the field.
• Ability to work in a fast-paced, result-driven, and complex healthcare setting.
• Ability to meet strict deadlines and communicate timelines
• Takes a sense of ownership
• Capable of embracing unexpected change in direction or priority.
• Highly motivated to solve problems; proven troubleshooting skills and ability to analyze problems by type and severity

Work Environment:

• Extensive telephone and computer usage.
• Use of computer mouse requires repetitive hand and wrist motion.
• Time off restricted during peak periods.
• Regular reaching, grasping and carrying of objects

This position may be modified to reasonably accommodate an incumbent with a disability. This job requires the ability to work with others in a team environment, the ability to accept direction from superiors and the ability to follow Company policies and procedures. Regular, predictable and dependable attendance is essential to satisfactory performance of this job.