Physician Authorization/Referral Specialist I

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Center for Health Care Strategies

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 1998

⚕️ Healthcare Insurance

🤝 Non-profit

🌍 Social Impact

Healthcare Insurance • Non-profit • Social Impact

Center for Health Care Strategies is a U. S. -based organization dedicated to improving the healthcare system to achieve better and more equitable outcomes, particularly for those served by Medicaid. The center focuses on issues like complex health and social needs, mental health, substance use, and aging and disability. It emphasizes cross-sector partnerships, community engagement, and health equity to transform the delivery system and promote value-based payments. The organization also supports leadership and capacity building efforts to drive system reform, including integrating Medicare and Medicaid services and advocating for trauma-informed care and primary care innovation.

📋 Description

• Ensure timely notification and request for authorization/referrals is handled in accordance with departmental policy and payor requirements. • Maintain confidentiality and verify patient demographics, insurance eligibility, benefits, and financial responsibility. • Ability to request/obtain authorizations/referrals for assigned specialties and cover for most specialties. • Communicate effectively, timely and professionally in writing and verbally. • Contact and interview families in person or by phone to obtain necessary information and assist with insurance issues. • Clearly document all communications and contacts with payors and families in standardized documentation requirements. • Consistently demonstrate excellent, empathetic and knowledgeable customer service skills. • Adhere to all State and Federal Regulations including, but not limited to: EMTALA, HIPAA, and the Joint Commission. • Ability to review workflows and suggest improvements in specialty areas. • Ability to work independently, prioritize workload, and assist other associates. • Build and maintain professional relationships with all departments that impact obtaining authorizations. • Prepare estimates for scheduled services, interpreting patient’s benefits for accuracy. • Work with partner hospitals for claim submission and registration accuracy.

🎯 Requirements

• Referral/authorization work experience required (minimum one year experience) • High School diploma required

🏖️ Benefits

• Health insurance • Medicaid enrollment processes • Supportive training for new team members