Insurance Authorization Specialist - Steward Health Care

Position Purpose:

This position will be a key member of PrimaCARE, P.C. Referral Department

Key Responsibilities:

• Serves as liaison between members of specific health plans and primary care providers and specialists to coordinate referrals and help members and providers navigate the PrimaCARE, P.C. Provider Network.
• Creates and processes referrals.
• Uses a referral data tool to manage and retain care within the PrimaCARE, P.C. network.
• Ensures accurate and timely processing of all requests.
• Receives incoming requests from physician practices and patients.
• Verifies eligibility and coverage.
• Communicates with physician practices and patients as needed.
• Confirms referrals with physician practices and patients.
• Assures that all necessary documentation occurs in a timely manner.
• Achieves established performance targets.
• Meets established quality expectations; e.g., confidentiality, accuracy, customer service, and professionalism.
• Verify and update patients insurances.
• Assist in updating Providers in electronic medical records system (NPI, Provider Name, Address, etc..)
• Upload hard copy of Insurance Referrals from carriers.
• Submit and follow up all Out of Network Insurance request.
• Supports other departmental team members to ensure turnaround time expectations are met.
• Communicates important information to team members.
• Contributes to team efforts to improve workflow and efficiency.
• Provides Outstanding Customer Service, going the extra mile to assure that customer expectations are met.
• Assists with other projects within the department on an "as needed" basis.
• Demonstrates respect and regard for the dignity of all patients, families, visitors, and fellow employees to ensure a professional, responsible, and courteous environment.
• Commits to recognize and respect cultural diversity for all customers (internal and external).
• Communicates effectively with internal and external customers with respect of differences in cultures, values, beliefs, and ages, utilizing interpreters when needed.
• Performs other duties as assigned.