Washington Referral Authorization Specialist

Job Summary

A company is looking for a Referral Authorization Specialist to coordinate prior authorizations and manage referrals while ensuring compliance with payer requirements.

Key Responsibilities

• Obtain prior authorizations for various healthcare services and manage outgoing referrals
• Monitor authorization and referral workqueues to ensure timely completion and communicate delays or denials to providers
• Collaborate with clinical and billing teams to minimize denials and assist with appeals as necessary

Required Qualifications

• High school diploma or equivalent required; Associate degree preferred
• Minimum of two years of experience in healthcare referrals, prior authorizations, or revenue cycle
• Experience with Medicare, Medicaid, and commercial payers preferred
• Understanding of medical necessity criteria and utilization management
• Certification such as Certified Healthcare Access Associate (CHAA) is preferred