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Overview

Overview

The prior authorization/referral specialist is responsible for ensuring that payers are prepared to reimburse Plumas District Hospital for scheduled services in accordance with the payer-provider contract.  The specialist contacts payers to request service authorization and may collect financial and/or demographic information from patients as needed.  When physicians and clinicians make care decisions, the authorization/referral specialist is aware of how a patient’s benefits fit into the care plan, and keeps patients and physicians informed of such as they seek to obtain authorizations from payers.

Qualifications

Education: High school diploma or GED equivalent and current CPR certification are preferred.

Experience:   Two years experience in the medical office/hospital field is preferred.  Medical terminology, familiarity with healthcare insurances and understanding of coding (ICD-10 and CPT) are also preferred.

Knowledge, Skills and Abilities:  Must be able to work independently with minimal supervision.   Ability to use a personal computer required.  Must type a minimum of 45 wpm, and be able to use a 10-key by sight.  Excellent interpersonal skills required.  Must have sufficient knowledge of verbal and English comprehension and expression to communicate clearly with callers, visitors and staff.  Knowledge of insurance plans, referral procedures, Worker’s Compensation program and of ICD-10 and CPT codes.

EOE

Minimum Education and Experience

Education Required: None
Minimum Hourly Wage: 15.55