Healthcare Referral & Authorization Pro

Care New England; Warwick, Northern (RI, KY); Hybrid; USD 42,000 - 70,000; Full time

Job summary

Care New England in Warwick, RI seeks a Referral and Authorization Specialist to oversee referrals and prior authorizations for specialty visits and outpatient testing. You will centralize workflows, verify insurance details, and coordinate with internal and external offices to minimize claim denials and ensure payer compliance.

The role supports timely patient care and optimized reimbursement by handling authorization requests, tracking statuses in the EHR, and communicating issues to

Qualifications

• 5-7 years of experience in healthcare.
• 3 years of experience processing insurance referrals and prior authorizations.
• Bilingual preferred.
• Knowledge of No Surprises Act and billing compliance.
• Excellent communication and organizational skills.

Responsibilities

• Request and obtain insurance referrals and prior authorizations; track status in the EHR.
• Evaluate payer policies for authorization requirements.
• Communicate request/status with internal offices via the EHR.
• Document all referral/authorization activities in the EHR.
• Coordinate information with internal/external offices for approvals.
• Verify patient insurance information for referrals/authorizations.
• Flag issues in the EHR and communicate them to the referring department.
• Escalate authorization issues to management.
• Manage external referral process for CNEMG PCPs and share docs.
• Explain non-covered service waivers and non-approved authorization waivers to patients.
• Monitor EHR queues and in-basket work items; perform other duties.

Skills

Healthcare billing terminology

EHR EPIC knowledge

Communication with diverse patients

Payer policy understanding

Education

High School diploma; CMA preferred

Tools

EPIC EHR

Microsoft 365

Job description

Care New England in Warwick, RI seeks a Referral and Authorization Specialist to oversee referrals and prior authorizations for specialty visits and outpatient testing. You will centralize workflows, verify insurance details, and coordinate with internal and external offices to minimize claim denials and ensure payer compliance.

The role supports timely patient care and optimized reimbursement by handling authorization requests, tracking statuses in the EHR, and communicating issues to