Referral & Authorization Specialist

Big Future Music Group; Templeton (CA); Hybrid; USD 33,000 - 40,000; Full time

Job summary

Heritage provider network seeks a Referral Coordinator to verify and interpret member health benefits and coordinate with clinics, providers, and DME vendors. You will ensure timely communication and accurate data entry, maintaining collaboration across departments.

Responsibilities include processing referrals, authorizations, and maintaining compliance with CMS timelines, HIPAA, and internal policies. Prior authorizations and strong organization are essential.

Qualifications

• High School diploma or GED is required.
• Minimum 1 year of experience in a medical office with prior authorizations.
• Knowledge of HCPC, CPT and ICD-10 is required.
• Proficient written and verbal communication skills.

Responsibilities

• Verify eligibility and interpret benefits using health plan and CMS websites.
• Prepare referrals and authorizations and refer to appropriate providers/facilities and DME suppliers.
• Coordinate with physician offices, processing staff and other departments to ensure smooth referral workflow.

Skills

Medical terminology

HIPAA compliance

Documentation

Education

High School diploma or GED

Job description

Heritage provider network seeks a Referral Coordinator to verify and interpret member health benefits and coordinate with clinics, providers, and DME vendors. You will ensure timely communication and accurate data entry, maintaining collaboration across departments.

Responsibilities include processing referrals, authorizations, and maintaining compliance with CMS timelines, HIPAA, and internal policies. Prior authorizations and strong organization are essential.