What are the responsibilities and job description for the Referral Specialist position at Aston Carter?
Description:
Summary: Assist in monitoring utilization of medical services to assure cost effective use of medical resources through processing prior authorizations.Job Responsibilities: Initiate authorization requests for outpatient and inpatient services in accordance with the prior authorization list. Route to appropriate staff when needed. Verify eligibility and benefits Answer phone queues and process faxes within established standards Data enters authorizations into the system.Education/Experience: High school diploma or equivalent. Knowledge of medical terminology preferred.0-2 years of experience
Skills:
prior authorization, project coordination, medical record, medical terminology
Top Skills Details:
prior authorization,project coordination,medical record
Additional Skills & Qualifications:
This job description applies to Utilization Management full time employees of Sunshine Health. This does not apply to temporary or contingent workers. JOB PROFILE SUMMARY: Position Purpose: Assist in monitoring utilization of medical services to assure cost effective use of medical resources through processing prior authorizations. Education/Experience: High school diploma or equivalent. 2 years of customer service experience. Required of medical terminology. Licenses/Certifications: N/A RESPONSIBILITIES MAY INCLUDE: • Ability to prioritize work assigned according to the turnaround times for each line of business. • Detail oriented. • Work all incoming authorization requests and tasks assigned in a timely manner and meet department goals. • Verify member’s eligibility and maintain integrity of personal health information. • Ability to manage heavy phone call volume and multitask. • Close collaboration with clinical teams and other departments. • Follows guidelines to meet standards for quality and compliance. • Attend ongoing training and in-services as directed. • Completes online educations as assigned within timeframe. • Provides coverage for team members as needed to support department. • Responds to daily incoming emails. • Issues letters within the applicable timeframe in accordance to the line of business. • Attends and participates in team meetings and conference calls.
Experience Level:
Entry Level
About Aston Carter:
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At Aston Carter, we’re dedicated to expanding career opportunities for the skilled professionals who power our business. Our success is driven by the talented, motivated people who join our team across a range of positions – from recruiting, sales and delivery to corporate roles. As part of our team, employees have the opportunity for long-term career success, where hard work is rewarded and the potential for growth is limitless.
Established in 1997, Aston Carter is a leading staffing and consulting firm, providing high-caliber talent and premium services to more than 7,000 companies across North America. Spanning four continents and more than 200 offices, we extend our clients’ capabilities by seeking solvers and delivering solutions to address today’s workforce challenges. For organizations looking for innovative solutions shaped by critical-thinking professionals, visit AstonCarter.com. Aston Carter is a company within Allegis Group, a global leader in talent solutions.
The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please call 888-237-6835 or email astoncarteraccommodation@astoncarter.com for other accommodation options. However, if you have questions about this position, please contact the Recruiter located at the bottom of the job posting. The Recruiter is the sole point of contact for questions about this position.
