Care Access Navigator: Referrals & Authorizations

Cone Health Medical Group; Greensboro (NC); On-site; USD 42,000 - 56,000; Full time

Job summary

Cone Health Medical Group seeks a Referral and Prior Authorization Specialist to coordinate referrals, pre-authorizations, and related patient access activities. You will serve as a liaison among patients, providers, payers, and external organizations to ensure timely access to care and accurate documentation.

The position requires at least two years in a healthcare setting focused on patient access, referral coordination, insurance verification, or revenue cycle.

Qualifications

• Requires high school diploma or GED.
• Two years of healthcare experience with patient access, referral coordination, insurance verification, or related responsibilities.
• Preferred CMA, CMAA, or applicable healthcare administrative certification.
• Experience with electronic medical records workflows is a plus.

Responsibilities

• Initiate, review and process referrals to specialists, ancillary providers, testing facilities, and community resources.
• Verify insurance eligibility and benefits using payer websites; flag potential coverage issues.
• Determine authorization requirements and obtain referrals, pre-certifications, and prior authorizations with supporting documentation.
• Coordinate referral appointments and documentation with patients, payers, and providers.
• Monitor referral and authorization queues; follow up with insurers and providers; document case status.
• Close referral loops by obtaining consultation reports and ensuring timely documentation in the EHR.
• Manage appeals and resolve denied or pending referrals and authorizations.
• Act as liaison between providers, insurance representatives and patients regarding referrals.
• Maintain confidentiality and comply with HIPAA and internal policies.

Education

High School Diploma or GED

Medical Assistant training

Medical office certification

Healthcare administration coursework

Related healthcare education

Job description

Cone Health Medical Group seeks a Referral and Prior Authorization Specialist to coordinate referrals, pre-authorizations, and related patient access activities. You will serve as a liaison among patients, providers, payers, and external organizations to ensure timely access to care and accurate documentation.

The position requires at least two years in a healthcare setting focused on patient access, referral coordination, insurance verification, or revenue cycle.