Job Title: Referral / Authorization Specialist
(Healthcare Experience REQUIRED)
Location: Must live on West Coast - Pacific Time Zone
Pay: $20.00 per hour
Work Arrangement: 100% Remote - Temp to Perm.
Experience Required: 1+ Years of Relevant Experience
Our organization is committed to enhancing the healthcare journey for our members. We are dedicated to delivering accessible, high-quality care tailored to the unique needs of our communities. As a Referral / Authorization Specialist, you will play a crucial role in ensuring our members promptly receive the services they require.
Summary: We are seeking a highly organized and detail-oriented individual to join our team. The ideal candidate will possess extensive knowledge of prior authorization and referrals processes, medical terminology, and ICD-10 coding. The primary responsibilities include processing faxes, building authorizations, and effectively communicating with healthcare providers. This role requires a strong understanding of medical billing codes, computer literacy, and the ability to ensure compliance with State and Federal healthcare regulations.
Inpatient Hospitalization Oversight:
Communication and Triage:
Data Entry and Database Management:
Eligibility and Benefits Verification:
Education and Experience:
Education: High school diploma or equivalent. Additional college coursework in healthcare administration or related fields is advantageous.
Experience: 1+ year of experience in referral and authorization coordination within the healthcare or managed care sector.
Technical Proficiency: Proficient in using computer systems and software, particularly Microsoft Office and relevant healthcare management applications.
Communication Skills: Strong verbal and written communication skills, with the ability to interact professionally with providers and internal teams.
Organizational Aptitude: Excellent organizational and time-management skills for managing multiple referrals and authorizations simultaneously.
Attention to Detail: A keen eye for detail is essential to ensure the accuracy of referral and authorization processes.
Problem-Solving: Effective problem-solving skills to address issues and discrepancies.
Adaptability: Ability to adapt to changes in policies and procedures.
Team Player: Collaborative and willing to work as part of a team to achieve shared objectives.