Referral and Prior Authorization Specialist

Job Summary

Managing patient referrals and prior authorizations, the full-time remote Referral and Prior Authorization Specialist will oversee compliance with enterprise standards, communicate with patients and clinical staff, and coordinate appointment scheduling and insurance authorizations.

Key responsibilities

• Oversee data management and compliance with referral and prior authorization guidelines while serving as a liaison between patients, referring offices, and specialists
• Prepare and submit prior authorization requests to insurance carriers, ensuring all necessary medical information is accurately communicated
• Manage complex appointment scheduling and coordinate ancillary testing for patients, ensuring timely access to care and adherence to protocols

Required qualifications

• High School diploma or equivalent with 2 years of relevant experience required
• Experience with surgical/appointment scheduling software and electronic medical records preferred
• Knowledge of medical terminology and insurance processes
• Ability to demonstrate customer relations skills effectively
• Experience in a healthcare setting is a plus