Authorization & Referrals Specialist III

This is a fully remote position, open to applicants in Connecticut, +2 more states.

📋 Description

• Validate insurance coverage using system tools and payer portals

• Confirm participation status of providers with patients’ insurance plans/networks

• Assess payer referral and authorization requirements for professional services

• Reach out to patients and primary care providers (PCPs) to obtain necessary referrals

• Record referrals in the practice management system

• Initiate authorization requests and submit clinical documentation required by insurance companies

• Handle faxes, emails, and phone calls promptly

• Relay authorization statuses or denials to surgical coordinators

• File appeals for denied prior authorizations or payments

• Calculate and document patient out-of-pocket estimates and communicate these to patients

• Assist supervisors with various special projects and tasks

• Support Specialists I and II with intricate referral, authorization, and eligibility cases

• Help distribute daily work assignments

• Contribute to new-hire and refresher training materials

• Monitor and restock office supplies

• Carry out other assigned responsibilities

⛳️ Requirements

• High school diploma or GED certificate is mandatory

• At least 2 years of experience in a physician’s billing or third-party payer environment

• Proficiency in understanding and navigating managed care eligibility, insurance billing requirements, and acquiring pre-authorizations

• Certification as a Professional Coder (CPC) is preferred

• Familiarity with Epic and/or other electronic billing systems is preferred

• Understanding of medical terminology, diagnosis, and procedure coding is preferred

• Prior experience in an academic healthcare setting is preferred

• Candidates must reside in the Tri-State area: New York, New Jersey, or Connecticut

🏝️ Benefits

• Healthcare

• Various additional benefits

• Paid Time Off

• Competitive comprehensive benefits package