Referrals and Prior Authorization Specialist

Key Responsibilities

• Manage prior authorization requests from insurance companies for medications, diagnostic imaging, and procedures.
• Process provider referrals promptly and ensure patients have timely access to specialty and imaging services.
• Offer patients options for in-network providers who are convenient to their homes and aligned with their preferences.
• Provide clear communication and assistance to patients in scheduling appointments with outside specialists or imaging facilities.
• Collaborate with healthcare providers, insurers, and patients to eliminate barriers to care.
• Maintain accurate records and track the status of authorizations and referrals.
• Perform additional duties as assigned by supervisors.

Qualifications

• Strong organizational skills and ability to multitask.
• Excellent communication and customer service skills.
• Proficiency with computers and ability to learn healthcare systems quickly.
• Experience with insurance prior authorizations and/or medical referrals preferred.
• Knowledge of health plan networks and medical terminology is a plus.