Medical Referral & Pre-Authorization Specialist

ABC Medical; Mount Juliet (TN); On-site; USD 23,000 - 32,000; Full time

Benefits offered by this job

Medical, Dental and Vision Insurance

401k Plan with Company Match

PTO and Paid Holidays

EAP

Employee Discounts

Job summary

ABC Home Medical Supply, Inc, located in Nashville, TN, is seeking a Referral Specialist to verify and process medical documentation for pre-authorizations and referrals. The role supports compliance with local coverage determinations and regulatory requirements, coordinating with physicians, insurers, and care teams.

The position emphasizes accuracy, timely communication with payors, and updating patient and document records while upholding HIPAA guidelines. Monday-Friday, 8:30am-5pm local time.

Qualifications

• High School Diploma or equivalent required.
• 2+ years of work experience preferred.
• Basic understanding of payor guidelines.
• Analytical and detail-oriented.
• Proficiency with Microsoft Office products.
• Ability to work well in a team environment.

Responsibilities

• Verify, obtain, review, and determine that medical documentation meets local coverage determinations and regulatory requirements.
• Pre-authorization functionality management.
• Examine documents for completeness and accuracy.
• Resolve discrepancies with document originators and approvers.
• Contact insurance companies to confirm coverage and eligibility of products.
• Obtain prior authorization and/or referrals.
• Update customer databases and filing systems accordingly.
• Generate communications for new and revised documents including pre-authorization requests.
• Maintain HIPAA compliance.

Skills

Analytical skills

Attention to detail

Organized

Microsoft Office

Team player

Education

High School Diploma or equivalent

Tools

Microsoft Office

Job description

ABC Home Medical Supply, Inc, located in Nashville, TN, is seeking a Referral Specialist to verify and process medical documentation for pre-authorizations and referrals. The role supports compliance with local coverage determinations and regulatory requirements, coordinating with physicians, insurers, and care teams.

The position emphasizes accuracy, timely communication with payors, and updating patient and document records while upholding HIPAA guidelines. Monday-Friday, 8:30am-5pm local time.