Work setting: potential to become fully remote after training
Responsibilities
Process and manage referrals received from external sources in a timely manner.
Ensure all required documentation is complete and accurate before initiating referral processing.
Review and complete Intake Referral Checklists to ensure all steps are followed.
Input patient demographic details, insurance information, and authorization data into the system.
Secure necessary authorizations and re-authorizations from payers, and document them accurately in the system.
Verify insurance coverage and ensure prior authorization is obtained before referral is sent to a pharmacist.
Maintain up-to-date knowledge of insurance companies that have contracts with Amerita.
Collaborate with internal departments, including Sales and Pharmacy, to update the status of referrals and discuss any specific authorization or out-of-pocket cost details that need to be communicated to patients.
Document progress notes in the computer system to track referral status and outcomes.
Notify patients and caregivers about insurance coverage details, payment obligations, and out-of-pocket costs.
Uphold strict confidentiality standards for patient and proprietary information.
Qualifications
High School Diploma/GED required; Associate's Degree or some college coursework preferred.
At least two (2) years of experience in collecting and processing referral information within the healthcare industry.
Experience with a variety of payer types, including Medicare, Medicaid, and commercial insurance.
Proficient in insurance verification, pre-certification, and authorization processes.
Knowledge of the services Amerita provides and the scope of coverage.