Job Description: Referral / Authorization Processor

Position Type: Contract to Permanent
Pay Rate: $22/hr + Various Benefits Plans offered with employer and employee contribution
Work Schedule: 100% Remote (Must work Pacific Time zone hours)
Location Requirements: No specific location requirements
Licensure Requirements: None

Schedules Available:

1. Tuesday - Saturday
2. Sunday - Thursday
3. Flexible schedule including both Saturday and Sunday (e.g., Wednesday - Sunday, Thursday - Monday, etc.)
   Working hours for all schedules: 8:30 AM - 5:00 PM (with a 30-minute lunch break)

Position Overview:
The Referral / Authorization Processor will work as part of the Care Access and Monitoring (CAM) team within a Managed Care Organization. This role involves processing referrals and authorizations, primarily supporting IP non-clinical teams. The processor will manage faxes, verify patient information, assist with inpatient status confirmations, and provide data entry support. The role requires a strong knowledge of medical terminology, prior authorization experience, and proficiency in working with ICD-10 and CPT codes.

Responsibilities:

• Process provider requests received via fax and build authorizations.
• Communicate with providers, answering calls and resolving inquiries.
• Verify member eligibility, benefits, and determine diagnosis and treatment requests.
• Assign appropriate billing codes (ICD-10, CPT/HCPC codes).
• Confirm inpatient hospital admissions and discharges, update census, and verify facility and IPA contact details.
• Assist with custodial care referrals and escalate to the appropriate team members.
• Provide excellent customer service to both internal and external clients.
• Collaborate with the Care Access and Monitoring team to ensure quality and cost-effective healthcare services.
• Maintain compliance with HIPAA and company confidentiality standards.
• Meet productivity, quality review, and attendance standards as required.

Knowledge/Skills/Abilities:

• Experience with prior authorizations, utilization review, and medical terminology.
• Ability to work effectively in a fast-paced environment, independently and as part of a team.
• Strong problem-solving and analytical skills.
• Excellent communication and customer service skills.
• Proficiency in data entry and Microsoft Office applications.
• Ability to enter data accurately at a minimum of 40 words per minute.

 

Education and Experience Requirements:

• High School Diploma/GED required.
• 2-4 years of experience in a Utilization Review Department in a Managed Care Environment.
• Previous experience in healthcare clerical, audit, or billing roles.
• Knowledge of medical terminology and prior experience in a hospital or healthcare setting.