Patient Access: Referrals & Authorization Expert

Frederick Health; Frederick (MD); On-site; USD 24,000 - 31,000; Full time

Job summary

Frederick Health is seeking a Referral Authorization Specialist to support patient insurance referrals, authorizations, eligibility, and price estimations for ambulatory services. This on-site, full-time role operates under the Patient Access and HIM Manager, ensuring compliance with FH standards and regulatory requirements.

You will act as the primary resource for referrals, obtain physician approvals when required, and perform extensive insurance knowledge to reduce denials and improve patient

Qualifications

• High school diploma or GED required; some college coursework preferred in Business/Health Sciences.
• Minimum two years healthcare revenue cycle billing and collections experience.
• Minimum one year experience in obtaining authorizations and pretermination.
• Understanding of medical terminology, CPT and ICD-10 codes.
• Knowledge of health insurance plans including Medicare, Medicaid, HMOs and PPOs.

Responsibilities

• Process pre-determination and authorization for services prior to delivery.
• Register and schedule for on-site and outpatient services.
• Obtain referrals and physician approvals as required by insurers.
• Verify patient demographics and insurance information.
• Provide premier customer service to patients and internal/external customers.
• Perform price estimations per payer fee schedules.
• Maintain knowledge of insurance requirements for referrals, authorizations and estimates.

Skills

Attention to detail

Time management

Verbal and written communication

Customer service

Teamwork

HIPAA/data security

Clinical knowledge

Education

High school diploma or GED

Some college coursework in Business/Health Sciences

Tools

Microsoft Word

Microsoft Outlook

Microsoft Excel

NextGen

Meditech

Meditech Expanse

Job description

Frederick Health is seeking a Referral Authorization Specialist to support patient insurance referrals, authorizations, eligibility, and price estimations for ambulatory services. This on-site, full-time role operates under the Patient Access and HIM Manager, ensuring compliance with FH standards and regulatory requirements.

You will act as the primary resource for referrals, obtain physician approvals when required, and perform extensive insurance knowledge to reduce denials and improve patient