Managed Care Specialist I: Authorizations & Referrals

Physicians East; Greenville (NC); On-site; USD 32,000 - 45,000; Full time

Job summary

Physicians East, P.A. in Greenville, NC seeks a Managed Care Representative I to maintain authorizations and referrals across departments.

The role involves reviewing authorization requests, verifying charted diagnoses, and coordinating with insurance companies to ensure timely approvals. Ideal candidates have a high school diploma (associates preferred), prior medical office experience, and strong computer skills.

Qualifications

• High School Diploma is required; Associates Degree is preferred.
• Experience in a medical office environment and Medical Terminology are required.
• Must have strong computer experience.
• Minimum of one year of patient/public contact experience.
• Minimum of one year of Managed Care Insurance experience is preferred.
• Must have a strong sense of team commitment, deadlines, punctuality and follow-through.
• Must display confidentiality, integrity, and initiative.

Responsibilities

• Maintain & process incoming and outgoing authorizations for assigned department(s).
• Communicate with Providers and Clinical team when orders are not in and/or additional information is needed to submit for authorization.
• Research 'Non-authorized' denials and obtain retroactive authorizations when applicable.
• Communicate with scheduling team when procedures have not been approved for preauthorization. Provide inter-departmental authorizations.
• Obtain prior approval authorizations for specialists performing test or procedures.
• Obtain in-patient authorization or precertification for hospital admissions.
• Notify appropriate personnel of any changes required by insurance companies.
• Route applicable procedures to the Cost Estimates team.
• Provide coverage for managed care co-workers during vacation, sickness, leave of absence, etc.

Skills

Communication skills

Teamwork

Computer proficiency

Confidentiality

Education

High School Diploma

Associates Degree

Job description

Physicians East, P.A. in Greenville, NC seeks a Managed Care Representative I to maintain authorizations and referrals across departments.

The role involves reviewing authorization requests, verifying charted diagnoses, and coordinating with insurance companies to ensure timely approvals. Ideal candidates have a high school diploma (associates preferred), prior medical office experience, and strong computer skills.