Pediatric Care Authorization & Referral Specialist

Nemours Children's Health; Wilmington (DE); On-site; USD 42,000 - 60,000; Full time

Job summary

Nemours Childrenb4s Health is seeking a Physician Authorization/Referral Specialist in the tristate area to ensure timely, coordinated care for patients.

The role involves verifying eligibility, communicating estimated patient costs, and obtaining referrals across specialties; collaborate with insurers, hospitals, and internal teams to maintain accurate records and support Medicaid enrollment while delivering excellent service.

Qualifications

• Minimum 1 year of referral/authorization work experience.
• Residence in PA, NJ, MD or DE as required.
• High School diploma required.

Responsibilities

• Obtain and process referrals and authorizations for outpatient services.
• Verify insurance eligibility, benefits, and patient cost estimates.
• Ensure copay requirements and payer approvals before services.
• Collaborate with insurers, providers, and internal teams to support communication.
• Maintain documentation in standard formats and support Medicaid enrollment where needed.
• Deliver empathetic customer service and comply with HIPAA and EMTALA.

Skills

Attention to detail

Customer service

Healthcare administration

Education

High School diploma

Tools

EPIC

Job description

Nemours Childrenb4s Health is seeking a Physician Authorization/Referral Specialist in the tristate area to ensure timely, coordinated care for patients.

The role involves verifying eligibility, communicating estimated patient costs, and obtaining referrals across specialties; collaborate with insurers, hospitals, and internal teams to maintain accurate records and support Medicaid enrollment while delivering excellent service.