Referral and Authorization Specialist - Hemetology/Oncology (Flexible scheduling options for Per-Diem positions)

The Impact You Can Make

Team Impact

The Referral and Authorization Specialist is responsible for obtaining authorizations as required from providers and payers to ensure all reimbursement requirements are met.

The Glens Falls Hospital Impact

Mission

Our Mission is to improve the health of people in our region by providing access to exceptional, affordable, and patient-centered care every day and in every setting.

How You Will Fulfill Your Potential

Responsibilities

ESSENTIAL FUNCTIONS

• Verify patient insurance eligibility & coordination of benefits. Prepare and compile necessary documentation to secure prior authorization. Collect clinical information regarding service to be rendered as applicable (J codes, CPT codes, ICD codes, Units) as well as medical records

• Interviews patients to apprise them of their insurance benefits contingent on the type of procedure / level of care to secure collection of patient financial obligations / secure payment arrangements

• Contact provider / payer to obtain prior authorization. Gather additional clinical and / or coding information as necessary in order to obtain prior authorization

• Maintain ongoing tracking and appropriate documentation of referrals & authorizations. Verify that all insurance requirements for procedures and admissions have been met.

• Verify via website or telephone that the authorization number(s) provided by providers are correct, that the location authorized is appropriate for the patients encounter and location, and verify validity dates. Ensure that services ordered are within benefit plan and approved for procedure / testing point of service as appropriate

• Verify medical necessity guidelines are met. Take appropriate action as necessary when guidelines are not met

• Monitor patient length of stay to ensure adequate coverage. Secure authorization for extended stay / set up payment arrangements as appropriate

• Provide follow up when insurance denials are received. Provide required documentation or information requested by insurers to facilitate payment

• Develop thorough knowledge of all medications / procedures performed and payer authorization requirements for each

• Understand insurance requirements for prior authorization / authorization. Serve as primary resource to Glens Falls Hospital staff regarding authorization requirements

• Serve as principal contact for clinical and / or department staff regarding prior authorization / authorization process for services to be rendered at Glens Falls Hospital or Glens Falls Hospital Health Centers

• Advise providers and their clinical staff when issues arise relating to obtaining prior authorization

• Stay informed and research information regarding new procedures and insurance coverage requirements

• Interact directly with providers and / or their clinical staff as necessary
  

OTHER FUNCTIONS

• Assist with the registration of patients when / if needed

• Assist with cashier duties / responsibilities when / if needed
  

Education/Accredited Programs

• High School Diploma or Equivalent

• Associates Degree or four (4) years of insurance experience in a healthcare environment preferred

Licenses/Certifications/Registrations

• None

Skills/Abilities

• Ability to type 60 WPM

• Knowledge of CPT and ICD coding desired; Knowledge of Medicare and third party payer regulations desired

• Ability to multitask and meet deadlines

• Ability to problem solve and work independently

• Strong organizational skills, effective interpersonal skills
  

Communities We Serve

Located in the foothills of the beautiful Adirondack mountains, Glens Falls is conveniently located a short drive away from the capital region and Lake George. Work at the top of your profession and jumpstart your next career here at Glens Falls Hospital!

All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law.

Salary Range
The expected base rate for this Glens Falls, New York, United States-based position is $18.25 to $26.87 per hour. Exact rate is determined on a case-by-case basis commensurate with experience level, as well as education and certifications pertaining to each position which may be above the listed job requirements.

Benefits
Glens Falls Hospital is committed to providing our people with valuable and competitive benefits offerings, as it is a core part of providing a strong overall employee experience. A summary of these offerings, which are available to active, full-time and part-time employees who work at least 30 hours per week, can be found here .