Authorization & Referral Specialist - Patient Access

Nemours in; Wilmington (DE); On-site; USD 42,000 - 64,000; Full time

Job summary

Nemours Children's Health is seeking a Physician Authorization/Referral Specialist I (Finance) to obtain and process referrals and authorizations for outpatient services, verify insurance eligibility, and communicate patient costs. You will collaborate with hospitals, providers, payors, and internal teams to ensure timely reimbursements and high-quality patient support.

You will follow department policies, document communications clearly, and support Medicaid enrollment processes while

Qualifications

• Referral/authorization work experience required (minimum one year)
• High School diploma required

Responsibilities

• Ensure timely notification and request for authorization/referrals per policy and payor requirements.
• Verify patient demographics, insurance eligibility, benefits, and financial responsibility.
• Request/obtain authorizations/referrals for assigned specialties and cover most specialties.
• Communicate effectively in writing and verbally.
• Interview families to obtain information and assist with insurance issues preventing authorization/referrals.
• Document all communications with payors and families in required format.
• Provide excellent customer service to internal and external customers.
• Adhere to EMTALA, HIPAA, Joint Commission regulations.
• Review workflows and suggest improvements in specialty areas.
• Work independently, prioritize workload, assist others as needed.
• Foster relationships with departments impacting authorizations.
• Prepare estimates for scheduled services and interpret benefits for accurate estimates.
• Coordinate with partner hospitals for claim submission and registration accuracy

Education

High School diploma

Job description

Nemours Children's Health is seeking a Physician Authorization/Referral Specialist I (Finance) to obtain and process referrals and authorizations for outpatient services, verify insurance eligibility, and communicate patient costs. You will collaborate with hospitals, providers, payors, and internal teams to ensure timely reimbursements and high-quality patient support.

You will follow department policies, document communications clearly, and support Medicaid enrollment processes while