Job Summary:


Responsible for initiating and completing Internal/External Referral requests received through Phone, Fax, Health Connect and On-Line Affiliate Link. Initiates and completes data entry utilizing a standardized documentation template along with established policies and procedures. Provides initial review of benefits and eligibility for services requiring authorization. Assigns or ensures correct ICD-10, HCPCS and CPT codes have been entered. Responsible for notifying members regarding referral/authorization orders, eligibility/benefit questions and scheduling appointments for external referral consultations, tests &/or procedures. Supports the daily activities of the QRM/Post-Acute Regional Review Team.

Essential Responsibilities:


+ Responsible for initiating and completing internal/external, pre-certification referral requests received.

+ Provides data entry on all authorization requests based on a documentation standard templa...