REFERRAL AUTHORIZAT SPECIALIST

Who We AreJPS Health Network is a $950 million, tax-supported health care system in North Texas. Licensed for 578 beds, the network features 75 locations across Fort Worth, with John Peter Smith Hospital -home to Tarrant County's first and only Level 1 Trauma Center, only psychiatric emergency services site, and the largest hospital-based family medical residency program in the nation - and more than 40 community-based clinics. All told, our network employs more than 7,200 people.

Acclaim is our multispecialty medical practice group featuring over 300 providers serving the JPS Health Network. Specialties range from primary care to general surgery and trauma. The Acclaim group formed around a common set of incentives and expectations supporting the operational, financial, and clinical performance

outcomes of the network. Our goal is to provide high quality, compassionate clinical care for every patient, every time.

Why JPS?We're more than a hospital. We're 7,200 of the most dedicated people you could ever meet. Our goal is to make sure the people of our community get the care they need and deserve. As community stewards, we abide by three rules:

1. Own it. Everyone who wears the JPS badge contributes to our journey to excellence.

2. Seek joy. Every day, every shift, we celebrate our patients, smile, and emphasize positivity.

3. Don't be a jerk. Everyone is treated with courtesy and respect. Smiling, laughter, compassion - key components of our everyday experience at JPS.

When working here, you're surrounded by passion, diversity, and dedication. We look forward to meeting you!

For more information, visit www.jpshealthnet.org.

To view all job vacancies, visit www.jobs.jpshealthnet.org/ or www.teamacclaim.org.

Job Title:

REFERRAL AUTHORIZAT SPECIALIST

Requisition Number:

26424

Employment Type:

Full Time

Division:

Community Health

Compensation Type:

Hourly

Job Category:

Support Services

Hours Worked:

8am - 5pm

Location:

Access Resource Center

Shift Worked:

Day

Job Description:

Description: The Referral Authorization Specialist is responsible for verification of insurance benefits and eligibility prior to submitting for authorization and pre-certification requirements. This position is responsible for scheduling appointments per approved protocols and guidelines as well as assist callers in accessing services and providing general healthcare related information as needed.

Typical Duties:

1. Coordinates with medical staff, payers, physicians, and patients regarding authorization status and options.
2. Maintains current referral procedures according to payer requirements.
3. Oversees inbound, outbound calls and/or review correspondence, documents and other referrals received via fax or email.
4. Initiate, follow up, and verify insurance eligibility and benefits for services ordered and document complete information in Epic referral notes.
5. Obtains prior authorizations as required by payer, including procurement of needed clinical documentation by collaborating with Clinical Care Team and payer. Obtain all authorizations via web, fax or phone.
6. Assist patient with finding resources that accept various insurances, when processing Outgoing/External referrals.
7. Determines patient's financial responsibilities as indicated by payer.
8. Configures coordination of benefit information and eligibility on every referral.
9. Documents all pertinent communication with patient, physician, and payer.
10. Reviews and manages Epic work queues to maintain accurate and timely authorization requests.
11. Schedules appointments as appropriate within required timeframes.
12. Serves as a resource liaison with referral/appointment inquiries from patients, clinical care teams, and other staff.
13. Meets productivity and documentation standards while following planned priorities as set by Patient Access Team Lead and/or Manager.
14. Performs other related job duties as assigned.

Qualifications:

Required Education and Experience:
• High School Diploma or GED equivalent.
• 1 plus years of progressive responsibilities and direct work related experience.
• 1 plus year of experience in a Patient Access/Patient Accounting role
Required Licensure/Certification/ Specialized Training:
• Completion of 90 day and annual competency based registration knowledge and skills assessments.
• Patient Access - General Consent Orientation and Patient Financial Experience Training (must be completed 30 days subsequent to hire)
Preferred Licensure/Certification/Specialized Training:
• Certified Healthcare Access Associate (CHAA)
• Bilingual in Spanish, Vietnamese, Arabic or other language.

Location Address:

1400 Circle Drive

Fort Worth, Texas, 76119

United States