Referral & Authorization Specialist

Hollister Incorporated; Tennessee; Hybrid; USD 42,000 - 66,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

401k with Match

PTO

Paid Holidays

Employee Discounts

Job summary

ABC Medical, part of the JDS, Inc family, is seeking a Referral Specialist to verify and pre-authorize medical documents in accordance with local coverage determinations and HIPAA guidelines.

The role involves coordinating with physicians, payors, and suppliers, maintaining data integrity, and ensuring timely pre-authorization and referrals while upholding compliance and customer service standards.

Qualifications

• Minimum qualifications: High School Diploma or equivalent work experience.
• 2+ years of work experience in a related role.
• Basic understanding of payor guidelines and HIPAA requirements.

Responsibilities

• Verify and review medical documentation for compliance and accuracy.
• Obtain prior authorization and referrals as required.
• Confer with providers and payors to resolve discrepancies.
• Update customer databases with new documents and pre-authorizations.
• Generate needed communication to healthcare providers and payors.
• Meet defined service level agreements and deadlines.

Skills

Analytical skills

Attention to detail

Team environment

Communication

Education

High School Diploma or equivalent

Tools

Microsoft Office

Job description

ABC Medical, part of the JDS, Inc family, is seeking a Referral Specialist to verify and pre-authorize medical documents in accordance with local coverage determinations and HIPAA guidelines.

The role involves coordinating with physicians, payors, and suppliers, maintaining data integrity, and ensuring timely pre-authorization and referrals while upholding compliance and customer service standards.