Onsite Referrals & Prior Authorization Specialist

Western Nephrology; Wheat Ridge (CO); On-site; USD 60,174,000 - 67,337,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Life insurance

Long term disability

Health Savings Account

401k with matches

Paid holidays

Paid time off

Pet insurance

Maternity/Paternity leave

Discount marketplace

EAP counseling

Ginger access

Talkspace access

Job summary

Western Nephrology is seeking a healthcare support professional to support clinic operations through prior authorizations, referrals, and patient scheduling. You will act as a bridge between patients, clinical teams, and insurance carriers to ensure timely care while navigating complex processes.

The role emphasizes meticulous documentation, HIPAA compliance, and collaboration with billing and clinic staff to minimize claim denials.

Qualifications

• 2 years handling provider referrals and prior authorizations in a specialty care setting.
• Excellent written and verbal communication skills with empathy and active listening.

Responsibilities

• Prior Authorizations & Referrals: Submit, track, and obtain prior authorizations and referrals for new and established patients; actively review databases to ensure all approvals are secured prior to appointment dates.
• Clinic & Billing Collaboration: Partner closely with clinic staff, providers, and billing teams to ensure authorization accuracy, communicate approval/denial statuses, and minimize claim denials.
• Patient Financial Navigation: Clearly answer patient inquiries regarding copays, deductibles, patient-responsible portions, and write-offs.
• Records & Administration: Process third-party medical record requests efficiently while maintaining strict compliance with HIPAA guidelines.

Skills

Prior authorizations

Provider referrals

Customer service

Tools

HIPAA compliance

Job description

Western Nephrology is seeking a healthcare support professional to support clinic operations through prior authorizations, referrals, and patient scheduling. You will act as a bridge between patients, clinical teams, and insurance carriers to ensure timely care while navigating complex processes.

The role emphasizes meticulous documentation, HIPAA compliance, and collaboration with billing and clinic staff to minimize claim denials.