Physician Authorization/Referral Specialist I

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🕒 June 25

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Center for Health Care Strategies

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 1998

🏥 Healthcare

💼 Consulting

⚕️ Healthcare Insurance

Healthcare • Consulting • Healthcare Insurance

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

• Obtain and process elective, urgent, and emergent referrals and authorizations for outpatient services, including cardiology, audiology, lab testing, genetic testing, and certain medications • Verify insurance eligibility and benefits and calculate and communicate patient cost estimates • Ensure copay requirements and approvals are completed before services occur • Work with insurance companies, primary care providers, partner hospitals, and internal departments to support accurate information and timely claim processing • Use daily reports and work queues to follow up on pending cases • Participate in department huddles and help resolve reimbursement-related issues • Deliver customer service and support Medicaid enrollment processes • Use EPIC effectively and assist with training new team members • Submit timely authorization and referral requests according to departmental policy and payor requirements • Maintain confidentiality and verify patient demographics, insurance eligibility, benefits, and financial responsibility • Request and obtain authorizations/referrals for assigned specialties and cover most specialties • Contact families in person or by phone to obtain information and assist with insurance issues • Document communications and contacts with payors and families using standardized requirements • Review workflows and suggest improvements • Prepare accurate estimates for scheduled services by interpreting patient benefits • Work with partner hospitals on claim submission and registration accuracy

🎯 Requirements

• Minimum one year of referral/authorization work experience required • High School diploma required • Ability to obtain authorizations/referrals for assigned specialties and cover most specialties • Effective, timely, and professional written and verbal communication • Ability to maintain confidentiality • Knowledge of insurance eligibility, benefits, copay requirements, and patient financial responsibility • Ability to accurately interpret patient benefits and prepare cost estimates • Familiarity with EMTALA, HIPAA, and Joint Commission requirements • Ability to review workflows and suggest improvements • Ability to work independently, prioritize workload, and assist other associates • Ability to build and maintain professional relationships across departments • EPIC proficiency • Customer service skills • Ability to support Medicaid enrollment processes

🏖️ Benefits

• No benefits or compensation extras are specified in the posting