Referral Specialist/Prior Auth. Specialist

Job Summary
We are seeking a detail-oriented and experienced Referral Specialist/Prior Authorization Specialist to join our healthcare team. The ideal candidate will be responsible for managing prior authorization requests, verifying insurance coverage, and ensuring compliance with HIPAA regulations. This role requires strong knowledge of managed care, medical coding, and medical office procedures to facilitate smooth patient care coordination and insurance processing. The position offers an opportunity to work in a fast-paced environment where accuracy and confidentiality are paramount.

Duties

• Manage and process prior authorization requests efficiently to ensure timely patient care.
• Verify insurance benefits and coverage details, including CPT, ICD-9, ICD-10, and ICD coding requirements.
• Review and interpret medical records, documentation, and provider notes for authorization purposes.
• Collaborate with healthcare providers and insurance companies to facilitate approvals and resolve any discrepancies.
• Maintain accurate and complete medical records in compliance with HIPAA regulations.
• Perform insurance verification to confirm patient eligibility and benefits prior to service delivery.
• Utilize medical terminology effectively when communicating with providers, insurers, and patients.
• Assist with medical office tasks related to referrals, authorizations, and documentation management.
• Ensure all activities adhere to managed care policies and healthcare regulations.

Qualifications

• Proven experience in a medical office setting or similar healthcare environment.
• Strong knowledge of managed care processes, medical coding (CPT, ICD-9, ICD-10), and insurance verification procedures.
• Familiarity with HIPAA regulations and maintaining patient confidentiality.
• Experience with medical records management and medical terminology.
• Excellent organizational skills with attention to detail in handling complex documentation.
• Ability to communicate effectively with healthcare providers, insurance companies, and patients.
• Office experience preferred; dental office experience is a plus.
• Knowledge of ICD coding systems (ICD-9/ICD-10) is highly desirable. This position offers a vital role within our healthcare team by ensuring seamless coordination between providers, insurers, and patients while maintaining compliance with industry standards.

Job Type: Full-time

Pay: $16.00 - $18.00 per hour

Benefits:

• 401(k)
• Paid time off

Work Location: In person

Salary : $16 - $18