Referral / Authorization Specialist (Remote)

Job Title: Referral / Authorization Specialist Location: Must live in the Central or Eastern Time Zone Work Arrangement: 100% Remote THIS POSITION REQUIRES EXPERIENCE IN HEALTHCARE Candidates must have 1+ years of managed care experience and/or medical office processing referrals / authorizations for medical services. Experience Required: 1+ Years of Relevant Experience (Healthcare Experience REQUIRED) Company Overview: 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. Essential Functions: Provide accurate and efficient computer entries for authorization requests and provider inquiries through phone, mail, or fax. Verify member eligibility and benefits to facilitate appropriate authorization procedures. Determine provider contracting status and ensure appropriateness for the requested services. Assess diagnosis and treatment requests, assigning appropriate billing codes (ICD-10 and/or CPT/HCPC codes). Verify coordination of benefits (COB) status for members. Verify and maintain inpatient hospital census, including admissions and discharges. Coordinate with healthcare providers to ensure timely and accurate information exchange. Communicate with healthcare providers, both verbally and in writing, to gather necessary information and address inquiries. Triage members and information to the appropriate Health Care Services staff, ensuring seamless workflow. Enter relevant data into systems accurately and promptly. Maintain up-to-date and comprehensive records of authorizations and related information. Check eligibility for members requiring hospitalization or utilization review for other healthcare services. Verify and communicate benefits information to relevant stakeholders. Qualifications: Proficiency in medical terminology, ICD-10 coding, and prior authorization processes. Strong computer literacy and experience with healthcare databases. Excellent organizational and multitasking skills. Effective communication skills, both written and verbal. Detail-oriented with a commitment to accuracy. Ability to work collaboratively in a team-oriented environment. Education and Experience: High school diploma or equivalent; Bachelor's degree in a related field is a plus. 1+ year of experience in referral and authorization coordination within the healthcare or managed care sector. Familiarity with State and Federal healthcare regulations. Apply tot his job