Referral Navigator Rep

Specific Duties

• Fax coordination for the Authorization Navigator Position
• Process and manage prior authorization requests and referrals in accordance with payer guidelines and organizational policies
• Review clinical documentation to ensure completeness and support authorization submissions
• Verify patient eligibility, benefits, and coverage requirements across commercial, Medicare, and Medicaid health plans
• Communicate with insurance carriers, provider offices, and internal teams to obtain authorizations and resolve issues promptly
• Maintain accurate records of authorization activities, payer communications, and case outcomes within designated systems
• Ensure compliance with HIPAA regulations and confidentiality requirements when handling patient information
• Carefully coordinate with healthcare providers, case managers, and managed care organizations to facilitate approvals and continuity of care
• Support health plan operations by identifying and addressing authorization-related barriers, escalating issues as needed

Requirements

• 2+ years of experience in prior authorizations, referrals, or healthcare operations
• Knowledge of insurance payer guidelines, authorization requirements, and medical terminology
• Experience coordinating referrals, authorizations, and healthcare documentation
• Strong organizational, multitasking, and communication skills in a fast-paced environment
• Familiarity with utilization management workflows, compliance standards, and audit processes

Skills/Attributes

Nice to have, and will set a candidate apart:

• Experience: 2-4+ years of experience in prior authorization processing, referrals, or healthcare operations
• Insurance Knowledge: Understanding of payer guidelines, authorization requirements, and basic medical terminology
• Additional Information: Experience with utilization management workflows, compliance standards, and audit processes

Benefits

PrideHealth offers a range of benefits including comprehensive healthcare coverage, supplemental coverage, retirement savings, life & disability insurance, an employee assistance program, legal support, pet insurance, and employee discounts with preferred vendors.

Equal Employment Opportunity

PrideHealth is an equal opportunity employer. We do not discriminate on the basis of race, religious creed, color, national origin, ancestry, physical disability, mental disability, reproductive health decision making, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, veteran or military status, or any other characteristic protected by applicable federal, state, or local law.

Accommodations

We are committed to providing reasonable accommodations to applicants and employees with disabilities. If you require a reasonable accommodation to participate in the application or interview process, or to perform the essential functions of this role, please contact us.