Authorization & Referrals Specialist

Mammoth Hospital; Mammoth Lakes (CA); On-site; USD 31,822 - 45,323; Full time

Job summary

Mammoth Hospital in Mammoth Lakes, CA is seeking an Authorization Clerk to manage insurance authorizations for patient procedures. You\'ll interact with hospital departments and third-party payers to ensure timely approvals.

The role requires attention to detail, strong communication, and knowledge of ICD-10/CPT and coding workflows; prior healthcare reception or utilization management experience preferred.

Qualifications

• High school diploma or equivalent required.
• Minimum of two years of healthcare/medical-reception/information experience preferred.
• Knowledge of Coding preferred.

Responsibilities

• Performs telephonic support for on-line authorization of routine services.
• Provides direct support to primary care practices and specialty care providers regarding utilization, authorization, and referral activities.
• Knowledge of ICD-10, CPT codes, and the use of 3 M software to code doctor\'s orders.
• Data enter referrals for non-complex services including DME, physical therapy, inpatient and outpatient care, behavioral health services and testing as applicable, and special circumstance requests as defined by Utilization Management.
• Assists in gathering information needed for coordinators/case managers to determine continued authorization.
• Contacts providers with authorization, denial and appeals process information.
• Verifies eligibility of members and participating status of providers.

Skills

Excellent communicator

Detail oriented

Interpersonal skills

Customer service

Education

High school diploma or equivalent

Job description

Mammoth Hospital in Mammoth Lakes, CA is seeking an Authorization Clerk to manage insurance authorizations for patient procedures. You\'ll interact with hospital departments and third-party payers to ensure timely approvals.

The role requires attention to detail, strong communication, and knowledge of ICD-10/CPT and coding workflows; prior healthcare reception or utilization management experience preferred.