Prior Authorization Representative (Referral Specialist)

Prior Authorization Representative (Referral Specialist) At Newport Orthopedic Institute, we take pride in bringing motion back to the lives of the patients we serve. As a subsidiary of Innovative Health Management Partner, the largest coastal orthopedic specialty group in Orange County, NOI has established a remarkable track record of innovation and medical care that enables our providers to improve the lives of our patients. Our facilities are located in Newport Beach, Huntington Beach, and Irvine. With NOI, you are given the opportunities and challenges you desire to embrace your potential and achieve your personal best every day. What you’ll find here is something special – it’s purposeful work done with a shared sense of community that brings us all together. We are a growing organization and have immediate openings for eager and driven professionals. Come join our world-class team of Board-Certified Physicians and professionals here in Newport Beach, California. The Prior Authorization Representative (Referral Specialist) is responsible for all aspects of the prior authorization/referral process including, but not limited to verifying insurances, ensuring that prior authorizations/referrals are obtained prior to procedures, and auditing the validity of past prior authorizations/referrals on file. Individual must possess an understanding of medications, insurances and medical terminology. Candidate will be working at our Newport Beach location. Potential to become a hybrid position. Confirms that prior authorization/referral has been obtained prior to the service date for surgeries, on-site MRI, pain management procedures and Ultrasound-Guided injections. Audits the validity and accuracy of prior authorizations/referrals. Communicate referral and authorization information to patients. Compile information concerning patients' clinical background and referral needs. Requests medical records, submitting appropriate clinical documents to specialist offices, and upload documents into electronic medical record platform. Monitors the status and completion of assigned tasks to outside vendors. Maintains constant and open communication with outside vendor to increase accuracy and efficiency of task completion. Provides up-to-date training and education of tasking processes, adhering to CMS recommendations. Able to expedite and complete urgent authorization requests as needed. Documentation of Authorization number and valid dates in NextGen. Schedule specialist appointments and/or diagnostic orders, as needed. Able to explain patient financial responsibility if indicated. Other duties as assigned. Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice. QUALIFICATIONS REQUIREMENTS: Experience in Gynecology-Oncology preferred Advanced knowledge of insurance, especially Medi-Cal, in addition to IPA and authorization processes preferred CPT Coding experience required Bilingual in Spanish or Korean preferred Workers Compensation knowledge preferred Fundamental knowledge of medical terminology and anatomy Proficient with Microsoft Office and medical practice management software Adheres to HIPAA, privacy, confidentiality and safety guidelines per office policies and protocol Typical Physical Demands This position often requires sitting, standing, walking, bending, twisting reaching with hands and arms, using hands and fingers, handling, constant talking, and hearing. Visual acuity to read computer screens and written materials. Also, must be able to lift over 10 pounds, occasionally. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. We are an equal opportunity employer. Typical Working Conditions Moderate noise. At times, a high volume of patients and tasks. Hybrid schedule, in-office and remote. Pay rate: $17-19 Qualifications Education Preferred Associates Experience Preferred CPT Coding Dealing with Medi-Cal insurances Gynecology-Oncology Behaviors Preferred Detail Oriented : Capable of carrying out a given task with all details necessary to get the task done well Functional Expert : Considered a thought leader on a subject Motivations Preferred Job Security : Inspired to perform well by the knowledge that your job is safe Goal Completion : Inspired to perform well by the completion of tasks Ability to Make an Impact : Inspired to perform well by the ability to contribute to the success of a project or the organization #J-18808-Ljbffr Newport Orthopedic Institute Apply tot his job Apply To this Job