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Pre-Auth/Referrral Rep
Category: Health Care Industry
  • Your pay will be discussed at your interview

Job code: lhw-e0-90672755

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VCU Health System

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  Job posted:   Thu Jun 7, 2018
  Distance to work:   ? miles
  5 Views, 0 Applications  
Pre-Auth/Referrral Rep

Pre-Auth/Referrral Rep

Req. #:

Referral Management

1601 Willow Lawn Drive, Ste 275, Richmond, VA 23230

Full time

1: Days


Job Details:
VCU Health System's Referral Management is seeking a full time Pre - Auth/ Referral Representative to support patient care by obtaining required insurance referrals and pre-authorizations in advance of patient's arrival. Interacts with patients, various insurance payers, internal and external clinical providers, clinic support staff, appointment schedulers and other related parties by telephone and in writing; reviews and extracts and provides clinical notes from patient's visits to the insurance payers in an effort to obtain the referral or secure a pre-authorization approval for scheduled appointments and tests prior to patient appointment. Ensures the disposition of each request is documented in IDX to support claims billing and reimbursement for outpatient services. In addition to documenting the outcome of the contact with insurance payers in the IDX-Web and CERNER, is responsible for establishing and maintaining online access with insurance payers, understanding and keeping current on updates for various health plans and being able to educate patients concerning their benefits, as it relates to pre-authorizations and referrals. Supports assigned clinics, working closely and effectively with Referral Management team members, to provide cross-team coverage and support as needed, for building good working relationships with staff in other supporting areas (i.e. CIVG, claims billing, medical records, etc.), and creating and maintaining a positive work environment. Responsibilities Assists patients with obtaining out-patient referrals by contacting PCP for all scheduled appointments requiring an HMO insurance referral. Contacts insurance companies to obtain pre-authorization approval for scheduled outpatient services. Verifies eligibility and benefits as part of the insurance referral and pre-authorization process through online verification tools or by telephone. Documents the outcome of the contact with insurance payers in the IDX-Web and CERNER. Qualifications Required High school graduate or equivalent Minimum of two (2) years of previous experience in a health care setting to include patient registration, customer service, medical insurance referral or pre-authorization Previous experience using a personal computer and various software applications, including Microsoft Excel and Word, e-mail, etc. Preferred Three (3) years of previous experience in medical insurance referrals and pre-authorization, medical billing environment, medical insurance verification and/or patient registration environment Previous experience in medical insurance (HMO and managed care), GE/IDX, Cerner, and clinical provider order entry Previous experience in ICD AND CPT coding Strong customer service skills and patient-centered focus. Previous experience using medical terminology
Qualified applicants will receive consideration for employment without regard to their protected veteran or disability status.

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