Description
Are you detail-oriented, organized, and passionate about healthcare support services? Virtual Staffing Solutions is currently expanding and is looking for Medical Authorizations Representatives to deliver high-quality, back-office support that ensures timely care for patients.
Key Responsibilities
- Obtains and processes referrals from providers and communicates authorizations with patients (via phone & mail) and medical staff in a timely manner.
- Prepares, processes, and completes referrals accurately and in a timely manner, including urgent and stat referrals for assigned members.
- Tracks referrals in the electronic medical records (EMR) system; Follows up on submitted authorization requests and maintains consistent status updates via EMR.
- Monitors and reports on status of authorization requests; escalates issues as necessary until fully resolved and the referral loop is closed.
- Communicates referral and authorization information and pertinent medical information to the patient and specialty providers.
- Manages the need for redirection across all clients and payers by working with clinical teams to ensure the timeliness of re-authorization ahead of expiry to avoid lapses in authorization or delays in patient care.
- Reviews consultation reports for needed follow-up requests and works with providers to ensure timely processing of all follow-ups.
- Works with the health information (medical records) department to ensure the timely retrieval of consultation reports.
- Assists the patient with scheduling appointments with the specialist, should the patient express any challenges in accomplishing this themselves.
- Submits retro-authorizations and distinguishes between primary care and internal specialty visits.
Skills, Knowledge & Expertise
- Must have at least 1 year BPO experience in US Medical Billing or a relevant field of work, with direct experience in handling the authorization process.
- Has a strong working knowledge of US billing, collection, coding, health care practices, laws, and regulations related to claims processing and collections.
- Ability to assign ICD-10 diagnosis codes and CPT code charges to patient charts with accuracy and attention to detail is a huge plus.
- Must be willing to work on-site.
About Virtual Staffing Solutions
We specialize in delivering innovative solutions and exceptional services to meet the diverse needs of our clients. With a strong commitment to quality and customer satisfaction, we strive to exceed expectations and drive success in every project we undertake.
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