Prior Authorization Specialist - Golden, CO

Receives, reviews and coordinates all information required to initiate a referral for pre-authorization for health care services for multiple practices. Follows protocols set up by New West Physicians and contracted payors.-- Utilized New West Physicians Practice Guidelines as required. Advises providers concerning the adequacy of the information contained in the referral.-- Makes suggestions within the protocols of the referral manual. Maintains accurate documentation of the referral in the patient's medical record. Maintains a communication log or tracking system for follow-up, data gathering and analysis. Communicates to patients and providers in the referral network in a timely manner the status or completion of the referral and any information required to ensure continuity of care to the patient.-- Documents communication as required to ensure service excellence. Maintains an effective working relationship with Medical Management staff of New West Physicians, with the office staff of referral providers, and with the office staff of contracted insurance companies.-- Documents communication as required to maintain service excellence. Communicates in a timely manner to patient's primary care physician referrals that are denied or that require more information for approval. Demonstrates critical thinking skills and effective communication skills in investigating breakdowns in the referral process to ensure positive working relationships with everyone involved. Demonstrates excellent customer service skills:-- warm, respectful, gracious, and courteous in all communications.-- Notifies practice manager of referral breakdowns and patient complaints. Educates patients and staff on changes in the referral process, alternatives available within the insurance plan and consequences of out-of-plan services. Maintains knowledge base of service plan benefits, criteria for plan enrollment and eligibility time-frames, and resources available to the patient within the plan for information on plan services. Other duties as assigned. -- You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications:

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