Referral Authorization Specialist

Socket.dev; Sierra Vista (AZ); On-site; USD 42,000 - 62,000; Full time

Benefits offered by this job

Comprehensive Benefits

Financial Protection & PTO

Financial & Career Growth

Employee Well-being

Professional Development

Job summary

Canyon Vista Medical Center in Sierra Vista, AZ is seeking a Referral Authorization Specialist to ensure timely access to care. The role includes processing referrals, completing pre-authorizations within three days, and maintaining EMR updates with each patient interaction.

Responsibilities also include communicating with patients and providers, staying current on health plan policies, and assisting with scheduling and coordination of care under physician or nurse supervision.

Qualifications

• High school diploma or equivalent required; two years of college preferred.
• Requires critical thinking, decisive judgment and the ability to work with minimal supervision.
• Must be able to work in a stressful environment and take appropriate action.

Responsibilities

• Processes referrals accurately and completely to ensure timely care and notifies providers of non-adherence.
• Completes pre-authorizations for diagnostic tests, therapy, surgical and specialty care within three days.
• Notifies patients when referrals are approved and informs providers when denied or when more information is needed.
• Updates referral info in the EMR after each communications with patient, insurer, nurse or provider.
• Maintains up‑to‑date knowledge of health plan policies and communicates changes to staff and patients.
• Identifies and helps resolve barriers to specialty care and coordinates with specialist offices.
• Tracks high-priority referrals to ensure follow-up for high-risk patients.
• Under supervision assists with patient assessments and treatments.
• Performs administrative duties: filing, reception, scheduling, data entry, patient registration.
• Performs other duties as assigned.

Skills

Critical thinking

Decisive judgment

Minimal supervision

Work under pressure

Education

HS diploma or equivalent

Two years college preferred

Job description

Your experience matters

Canyon Vista Medical Center is part of Lifepoint Health, a diversified healthcare delivery network with facilities coast to coast. We are driven by a profound commitment to prioritize your well-being so you can provide exceptional care to others. As a Referral Authorization Specialist joining our team, you’re embracing a vital mission dedicated to making communities healthier®. Join us on this meaningful journey where your skills, compassion and dedication will make a remarkable difference in the lives of those we serve.

How you’ll contribute

A Referral Authorization Specialistwho excels in this role:

• Ensures patients receive the care they need in a timely manner by processing referrals accurately and completely, verifying that patients receive the required care, and notifying providers when patients do not follow through with referrals.


• Completes pre-authorizations for all diagnostic testing, therapy, surgical, and specialty care appointments according to insurance requirements within three days of issuance.


• Notifies patients when referrals are approved and notifies providers when referrals are denied or when a second opinion or additional information is required. Documents all communication with patients, nurses, and/or providers in the clinic EMR.


• Updates referral information in the EMR following each communication with a patient, insurance provider, nurse, or provider.


• Maintains up-to-date knowledge of health care plans and interprets and communicates changes to plan policies and procedures to employees, physicians, and patients.


• Identifies and attempts to resolve barriers to specialty care, including assisting with appointment scheduling and coordinating with specialist offices.


• Assists with tracking high-priority referrals to ensure patients in high-risk categories receive necessary follow-up care.


• Under the supervision of a physician or nurse, assists with performing patient assessments and treatments.


• Performs administrative and clerical duties as assigned, including filing, reception, scheduling, data entry, and patient registration.


• Performs other duties as assigned.

What we’re looking for

Education:

• High school diploma or equivalent required; Two years of college preferred.
  

Skills:

• Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision.


• Must be able to work in a stressful environment and take appropriate action.

Schedule:

Full-time

Why join us

We believe that investing in our employees is the first step to providing excellent patient care. In addition to your base compensation, this position also offers:

• Comprehensive Benefits:Multiple levels of medical, dental and vision coverage for full-time andpart-time employees.


• Financial Protection & PTO:Life, accident, critical illness, hospital indemnity insurance, short- and long-term disability, paid family leave and paid time off.


• Financial & Career Growth:Higher education and certification tuition assistance, loan assistance and 401(k) retirement package and company match.


• Employee Well-being:Mental, physical, and financial wellness programs (free gym memberships, virtual care appointments, mental health services and discount programs).


• Professional Development:Ongoing learning and career advancement opportunities.

More about Canyon Vista

Canyon Vista Medical Center is a 106-bed acute care hospital that has been offering exceptional care for over 60 years. We are proud to serve our community with a Level III Trauma unit, Center of Excellence for Total Joint Replacement, Level I Nursery, American College of Radiology Accredited Facility, as well as many other state of the art services to ensure our patients are cared for.

Sierra Vista, Arizona is a flourishing city located 75 miles southeast of Tucson. Thanks to our year-round temperate climate, affordable housing, low cost of living, access to healthcare and education facilities, not to mention the breathtaking natural beauty of majestic mountain ranges and the San Pedro River and outdoor activities, Cochise County residents enjoy an excellent quality of life.

EEOC Statement:

Canyon Vista Medical Center is committed to providing Equal Employment Opportunities for all applicants and employees and complies with all applicable laws prohibiting discrimination against any employee or applicant for employment because of color, race, sex, age, religion, national origin, disability, genetic information, gender identity, sexual orientation, veterans' status or any other basis protected by applicable federal, state or local law.

Lifepoint Health is a leader in community-based care and driven by a mission of Making Communities Healthier. Our diversified healthcare delivery network spans 29 states and includes 63 community hospital campuses, 32 rehabilitation and behavioral health hospitals, and more than 170 additional sites of care across the healthcare continuum, such as acute rehabilitation units, outpatient centers and post-acute care facilities. We believe that success is achieved through talented people. We want to create places where employees want to work, with opportunities to pursue meaningful and satisfying careers that truly make a difference in communities across the country.

We employ and provide care to people from all walks of life. We are committed to promoting healing, providing hope, preserving dignity and producing value with an inclusive workforce in which diversity is leveraged, respected, and reflective of the patients, family members, customers and team members we serve.