PT/OT Referral Authorization Specialist

Job Description

Job DescriptionDescription:

Excel Orthopaedic Specialists in Woburn is hiring. We are a busy Orthopedic practice looking to hire a Referral/Authorization Specialists to add to our expanding team. The Referral / Authorization Specialist is responsible for processing referrals and prior authorizations to ensure that patient visits and procedures are covered by various payers.

• Proactively reviews OT and PT therapy schedules to determine which patients need referral or prior authorizations
• Verifies patient eligibility (insurance, worker’s comp, MVA)
• Prepares, processes and tracks referrals and prior authorizations through various payer systems, documents all in eCW per protocol
• Makes follow up calls to patients and payers (insurance company, workers comp, etc)
• Responds to questions and requests from leadership, providers, payers and patients
• Demonstrate professional communication and problem solving with providers and leadership, participate in process improvement and educate teams on updated guidelines and/or process.
• Completes other tasks as directed by management.
• Attends staff meetings and continuing education

Requirements:

• High school diploma required, Bachelor’s degree in related field preferred
• Minimum of two years’ experience in medical and/or rehab billing and/or referrals/ prior auths
• Knowledge of medical terminology required
• Demonstrated ability to handle high volume of calls and claims in a fast paced environment
• Excellent verbal and written communication skills
• Strong computer skills including EMR and MS Office