Medical Referrals & Authorization Specialist

Apex Systems; Modesto, Northern (CA, KY); Hybrid; USD 34,000 - 41,000; Part time

Benefits offered by this job

Benefits package

401(k) match

HSA program

Job summary

Everforth Apex Systems is seeking a Referral Coordinator to review, evaluate, and process referrals for outside medical services onsite in Modesto, CA. You will determine insurance coverages and service codes while researching eligibility and securing required approvals.

You will provide customer service to stakeholders via phone and email, update multiple systems, and support clinical staff to ensure timely authorizations. This is a contract, onsite role with a focus on accuracy and efficiency.

Qualifications

• High School Diploma or GED required.
• Associate degree or 2 years related experience in accounting or a related field preferred.
• Experience in medical assistance, utilization management/authorization, or coding in a hospital or clinic environment preferred.

Responsibilities

• Review, evaluate, and process outside medical service referrals for completeness and timeliness.
• Determine insurance coverages (HMO, Medicare/Medical) and service codes.
• Research referrals to determine eligibility and obtain approvals.

Skills

Excel

Medical terminology

Customer service

Clerical work

Phone & email support

Prior authorizations

Education

High school diploma or GED

Associate degree or 2 years related experience

Tools

Health information systems

Medical records/database systems

Job description

Everforth Apex Systems is seeking a Referral Coordinator to review, evaluate, and process referrals for outside medical services onsite in Modesto, CA. You will determine insurance coverages and service codes while researching eligibility and securing required approvals.

You will provide customer service to stakeholders via phone and email, update multiple systems, and support clinical staff to ensure timely authorizations. This is a contract, onsite role with a focus on accuracy and efficiency.