Prior Authorization & Referrals Specialist

Carolina Pines Medical Group; Hartsville (SC); On-site; USD 33,000 - 52,000; Full time

Job summary

Carolina Pines Regional Medical Center in Hartsville, SC seeks a Pre-Cert and Referrals Clerk to obtain prior authorizations for all procedural orders with commercial payers. You will schedule outpatient tests, verify coverage, and document in Athena.

You will work with providers to resolve denials, inform patients of appointments, and support the office team in ensuring accurate coding and timely insurance follow-up. Prior authorization experience is preferred.

Qualifications

• 2 years medical prior authorization/referrals experience preferred.
• 2 years of experience in a medical related field required.

Responsibilities

• Schedules outpatient diagnostic tests and referrals and documents in Athena.
• Maintains knowledge of insurance carrier requirements and obtains necessary authorization.
• Works with referring providers to resolve denials or requests for additional information.
• Notifies patients of scheduled appointments and records acknowledgement.
• Verifies order accuracy and coding using CPT/ICD-9 guidelines.
• Contacts carriers to verify claim status and to resolve processing problems.
• Performs related administrative tasks as directed by team lead.

Skills

Critical thinking

Decisive judgement

Minimal supervision

Stress handling

Education

High School Diploma or Equivalent

Tools

Athena EMR

Job description

Carolina Pines Regional Medical Center in Hartsville, SC seeks a Pre-Cert and Referrals Clerk to obtain prior authorizations for all procedural orders with commercial payers. You will schedule outpatient tests, verify coverage, and document in Athena.

You will work with providers to resolve denials, inform patients of appointments, and support the office team in ensuring accurate coding and timely insurance follow-up. Prior authorization experience is preferred.