Referral specialist vs authorization specialist

Differences between referral specialist and authorization specialist duties and responsibilities

Referral specialist example responsibilities.

• Manage assignments of paying medical bills limit in depth that include organizing and researching regulations as pertain to veterans eligibility.
• Interview patients, evaluate eligibility, collect co-pays, deductibles, including, but not limit to insurance verification.
• Input HIPAA information, call physician offices to verify testing, collect copay's and deductibles.
• Arrange for debt repayments or establish repayment schedules and send out insurance claims with the correct ICD-9 and CPT codes.
• Research referrals and either deny or approve based on information obtain and appropriately identify diagnosis (CPT and ICD-9 coding).
• Maintain confidentiality by following all applicable HIPAA regulations.
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Authorization specialist example responsibilities.

• Demonstrate knowledge of HIPAA by appropriately managing patient confidentiality.
• Utilize CMS and InterQual criteria to establish authorizations for members requiring medical services for a Medicare advantage insurance company.
• Build authorization, match ICD-10 codes with there procedure codes
• Provide patients with patient registration forms in order to follow up on patient check-in and check-out utilizing a proprietary management system.
• Obtain verification of insurance coverage and authorizations for clinical visits and surgical procedures for patients.
• Perform all components of the office registration including arrival, check-in and future appointments.
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