Job Title: Authorizations and Referral Specialist Summary: Performs a variety of moderately complex duties requiring a sound knowledge of credentialing procedures and practices by performing the following duties. Essential Duties and Responsibilities: Responsible for maintaining an open communication line with employees, customers, and vendors, while maintaining proper confidentiality, to ensure proper handling of all credentialing issues that may arise. Responsible for maintaining all records and files associated with credentialing. Process insurance networks, healthcare organizations and hospitals to obtain and evaluate documentation regarding a medical provider’s education, training, work history, licensure, and regulatory compliance record and malpractice history. Prepare their own records for regular audit, as well as maintain close communication with all appropriate practitioners to ensure that records are up-to-date and consistent. Procedures, documents and tracks primary source verification letters, including follow-up second and third request as specified in policy and procedure manual(s).Verifies hospital privileges, education/board certification, malpractice and medical licenses.Documents actions taken to complete verification of required information. Faxing, copying, filing and composing letters of denial, acceptance and deferral.Interacts with contacts both inside and outside of company to facilitate completion of job duties, projects, and special assignments.Responds to non-routine correspondence or telephone contacts in area of authorized responsibility.Answers correspondence not requiring supervisor’s attention.Prepares and processes all managed care referrals.Gathers pertinent data from physicians, nurse practitioners, and nursing staff to complete referrals.Contacts various offices/ facilities to obtain necessary information to accurately complete referral requests.Maintains referral records and files documentation.Responds to patient inquiries regarding health plan referrals.Any other duties and tasks as assigned by the management. Qualifications:To perform this job successfully, and individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Must be well-organized and detail oriented. Educational Requirements:High school diploma: One to two years related experience and/or training; or equivalent combination of education and experience. Language Skills: Ability to read and interpret documents such as policies and procedures, governmental regulations and technical procedures. Ability to write routine reports and business correspondence. Ability to speak effectively and present information to large groups. Reasoning Ability: Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.