Referral & Authorization Specialist

Johnson Memorial Health; Kansas; On-site; USD 42,000 - 56,000; Full time

Job summary

Johnson Memorial Health is seeking a Referral Specialist in Family Medicine to verify insurance coverage, initiate referrals, and manage prior authorizations. The role acts as a liaison among hospitals, physicians, patients, and health plans while educating staff on insurance changes related to referrals.

The candidate will assist with patient eligibility checks, EMR documentation, and scheduling, while upholding the organization’s mission and values across departments and external facilities.

Qualifications

• High School Diploma or equivalent required.
• Prefer 1-2 years of work experience in a medical or physician office setting.
• General knowledge of information systems and EMR technology experience preferred.

Responsibilities

• Verifies insurance coverage to initiate and/or perform the referral process.
• Completes prior authorization processes and coordinates between hospitals, physicians, patients, and health plans.
• Authorizes insurance information and verifies patient eligibility to prevent scheduling with unapproved specialists.
• Educates physicians and staff on insurance changes related to referrals and authorizations.
• Stays up to date with contractual obligations to specific insurance companies.
• Communicates with patients about approvals and denials for authorizations.
• Maintains knowledge of ICD-10 codes and primary diagnoses.
• Scans documents into the EMR and ensures patient records are accurate.
• Performs PSR duties at the check-in/out desk when covering PSR position.
• Greet patients and visitors, verify demographics and insurance, and complete registrations.
• Answers multi-line phone calls and schedules appointments as needed.
• Supports the Mission and Values of Johnson Memorial Health and collaborates with staff and external facilities.

Education

High School Diploma or equivalent

Job description

Johnson Memorial Health is seeking a Referral Specialist in Family Medicine to verify insurance coverage, initiate referrals, and manage prior authorizations. The role acts as a liaison among hospitals, physicians, patients, and health plans while educating staff on insurance changes related to referrals.

The candidate will assist with patient eligibility checks, EMR documentation, and scheduling, while upholding the organization’s mission and values across departments and external facilities.