St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care.
Position will include contacting patients with test results, triaging phone calls, entering orders, scheduling appointments.
The Practice Prior Authorization and Referral Specialist is responsible for the coordination of prior-authorizations and referral process for patients being referred for specialty care, medications, and diagnostic procedures. Performs insurance verification, obtaining pre-authorizations, scheduling, and referrals. The specialist will secure the necessary prior authorization, then notify the patient aiding in the coordination of patient care.
JOB DUTIES AND RESPONSIBILITIES:
Receive request for patient requiring specialty care through the electronic health record (EHR), direct order by provider communication, phone, and/or fax.
Ensure patient demographic as well as insurance information are most accurate.
Reviews patient insurance information and eligibility / verification to obtain prior authorization for specialty care and/or services.
Obtain prior authorization from insurance companies prior to services being ordered and/or rendered.
Documents in EHR prior authorization approval to ensure proper reimbursement.
Works in collaboration with other supporting services / entities, central scheduling, and pre-encounters department.
Responds to written as well as telephone inquires from patients, insurances, pharmacies, other outpatient/inpatient departments, and facilities regarding planned specialty care and/or services.
Review and follow up on authorization and/or claim denials.
Notify ordering provider of a prior authorization denials and if peer to peer need to be scheduled.
Other duties as assigned.
PHYSICAL AND SENSORY REQUIREMENTS:
Sitting for up to 8 hours per day, 3 hours at a time. Consistent use of hands and fingers for typing, telephone, data entry, etc. Occasional twisting and turning. Uses upper extremities to life and carry up to 15 pounds. Stoops, bends, and reaches above shoulder level to retrieve needed materials. Hearing as it relates to normal conversation. Seeing as it relates to general vision.
EDUCATION:
High school diploma or equivalent required. Prior authorization experience preferred.
TRAINING AND EXPERIENCE:
One to two years of experience in medical billing, a medical office or insurances preferred. Working knowledge of medical office procedures as well as detailed understanding of ICD 10 and CPT codes. Knowledge of regulatory standards and compliance requirements.
Please complete your application using your full legal name and current home address. Be sure to include employment history for the past seven (7) years, including your present employer. Additionally, you are encouraged to upload a current resume, including all work history, education, and/or certifications and licenses, if applicable. It is highly recommended that you create a profile at the conclusion of submitting your first application. Thank you for your interest in St. Luke's!!
St. Luke's University Health Network is an Equal Opportunity Employer.
St. Luke's University Health Network is a regional network of hospitals, physicians and other related organizations providing care primarily in Lehigh, Northampton, Monroe, Carbon, Schuylkill, Bucks, Montgomery and Berks counties in Pennsylvania and Warren County in New Jersey.
The Network provides services at more than 150 sites. St. Luke's University Health Network is comprised of six hospital sites. The Network includes:
Areas of exceptional medical expertise include:
St. Luke's offers an exceptional benefit plan for employees. Our values are reflected in all we do for patients, each other and the community:
Pride - We take pride in our accomplishments and in our organization.
Caring - We show consideration for others and their feelings. We treat others as we want to be treated.
Respect - We recognize the value, diversity and importance of each other, those we serve and the organization.
Accountability - We are responsible to make decisions and solve problems in a timely and effective manner.
Flexibility - We adapt to the changing needs and expectations of those we serve.
Teamwork - We work together to improve quality.
The mission of St. Luke's University Health Network is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care.