Referral & Authorization Specialist - Care Lane Hematology/Oncology Clinic

Compensation: $18.50 to $27.76 per hour (Exact rate is determined on a case-by-case basis commensurate with experience level, as well as education and certifications pertaining to each position which may be above the listed job requirements.)

The Impact You Can Make

Join our team of insurance experts at Glens Falls Hospital! As a Referral & Authorization Specialist, you will be the vital link between oncology patients, providers, and insurance payers. Your expertise directly reduces patient stress and ensures seamless access to life-saving cancer treatments. This role is a prime launching pad to elevate your skills in medical billing, compliance, and Health Information Management (HIM).

How You Will Fulfill Your Potential

Responsibilities

• Secure Approvals: Verify patient insurance eligibility, check medical necessity guidelines, and obtain prior authorizations from payers.

• Patient Advocacy: Counsel patients on their insurance benefits, navigate financial obligations, and resolve coverage questions.

• Clinical Support: Act as the central point of contact for Glens Falls Hospital clinic staff regarding authorizations, stay updated on new procedure guidelines, and assist with monitoring patient waiting workflows when needed.

• Team Resource: Act as the primary resource for clinical staff regarding authorization rules, and notify providers of any insurance obstacles.

• Denial Management: Track ongoing referrals and lead the follow-up process for insurance denials to secure proper reimbursement.

• Maintain Compliance: Compile necessary medical records, clinical notes, and coding info (CPT/ICD) to submit accurate documentation.

Qualifications/Experience

• Education/Accredited Programs

  • Required: High school diploma or GED equivalent.

  • Preferred: Associate degree (AAS) in Health Administration, Business, Finance, or a related field.

• Experience/Abilities

  • Experience: 4 years of healthcare insurance experience preferred (can substitute for an Associate degree).

  • Knowledge: Familiarity with medical terminology, CPT/ICD coding, and Medicare/third-party regulations is highly desired.

  • Tech Skills: Fast and accurate typing skills (60 WPM preferred) and excellent computer proficiency.

  • Soft Skills: Exceptional customer service, multitasking abilities, and strong verbal/written communication skills.