Prior Authorization & Referral Specialist - Dental

DUTIES AND RESPONSIBILITIES:

• Coordinates all referrals to specialist practices and local-regional healthcare services.
• Process referral requests for patients for specialty services and diagnostic imaging.
• Provide appropriate customer service and answer patient inquiries.
• Maintain established tracking system of referrals--both external and internal.
• Provide information and support to dental providers regarding patient referrals.
• Uses sound judgment with patient scheduling efforts and utilization of resources.
• Documents and traces interaction with clients and appointments, assisting with data entry.
• Performs Prior Authorization for patients before scheduled procedures.
• Perform other duties as may be delegated by the Chief Compliance Officer or designee.
• Obtain current identification for managed care, prepare pre-certification as required including patient diagnosis as documented by primary care physician.
• Make appointments and request follow-up information.
• Review and explain process for referral to patient, including but not limited to what to expect, who providers are and how to get to hospital or referral specialist’s office.
• Review rejected requests for procedures or visits.
• Maintain up-to-date knowledge of referral guidelines, active providers, necessary coverage information, insurance requirements necessary for pre-certification.
• Maintain adequate records for risk management on referrals completed of patients needing to be seen outside of API.
• Compile monthly report for administrative review.
• Mail, fax or communicate appropriate records, certificates and authorizations to appropriate persons for the completion of the referral process.

Minimum Qualifications

•  General knowledge of the various Dental services in the Tri-State area.
• Knowledge of medical terminology
• Excellent organizational skills including oral and written communication skills. 
• Ability to work independently; excellent interpersonal skills; basic computer skills. 
• Ability to relate to people from a variety of socio-economic and ethnic backgrounds.
• Prior medical/Dental office experience required with 1-3 years of related medical office and/or community experience considered.
• Must be self-motivated and organized.
• Previous referral experience preferred. 
• Must be multi-tasked and complete duties with minimal supervision