Authorization & Referrals Specialist III

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

📋 Description

• Verify insurance coverage using system tools and payer portals

• Confirm the participation status of providers with patient insurance plans/networks

• Identify 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 authorizations and provide requested clinical documentation

• 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 cost estimates

• Assist supervisors with special projects and tasks

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

• Help in the distribution of daily work assignments

• Aid in new-hire and refresher training

• Monitor and replenish office supplies

• Perform other assigned responsibilities

⛳️ Requirements

• High school diploma or GED certificate is required

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

• Capability to understand and navigate managed care eligibility, insurance billing requirements, and obtaining pre-authorizations

• Certification as a Professional Coder (CPC) is preferred

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

• Familiarity with medical terminology, diagnosis, and procedure coding is preferred

• Previous 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 other benefits

• Paid Time Off

• Competitive comprehensive benefits package