Referral/Authorization Specialist

Western Nephrology; Wheat Ridge (CO); On-site; USD 60,174,000 - 67,337,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Life insurance

Long term disability

Health Savings Account

401k with matches

Paid holidays

Paid time off

Pet insurance

Maternity/Paternity leave

Discount marketplace

EAP counseling

Ginger access

Talkspace access

Job summary

Western Nephrology is seeking a healthcare support professional to support clinic operations through prior authorizations, referrals, and patient scheduling. You will act as a bridge between patients, clinical teams, and insurance carriers to ensure timely care while navigating complex processes.

The role emphasizes meticulous documentation, HIPAA compliance, and collaboration with billing and clinic staff to minimize claim denials.

Qualifications

• 2 years handling provider referrals and prior authorizations in a specialty care setting.
• Excellent written and verbal communication skills with empathy and active listening.

Responsibilities

• Prior Authorizations & Referrals: Submit, track, and obtain prior authorizations and referrals for new and established patients; actively review databases to ensure all approvals are secured prior to appointment dates.
• Clinic & Billing Collaboration: Partner closely with clinic staff, providers, and billing teams to ensure authorization accuracy, communicate approval/denial statuses, and minimize claim denials.
• Patient Financial Navigation: Clearly answer patient inquiries regarding copays, deductibles, patient-responsible portions, and write-offs.
• Records & Administration: Process third-party medical record requests efficiently while maintaining strict compliance with HIPAA guidelines.

Skills

Prior authorizations

Provider referrals

Customer service

Tools

HIPAA compliance

Job description

This position is onsite only - there are no hybrid or remote options available. Days of work are Monday through Friday. The hours may vary from 8:00 am–5:00 pm or 8:30 am-5:00 pm depending on length of lunch.

INSPIRED CULTURE

Our culture will provide you with flexibility and continuous career development. Be authentically recognized at work and find your sense of purpose with us in a critical specialty that affects patients’ quality of life. Devoted staff are essential to our patient care model. We’ll work hard and take care of each other while providing the best care for our patients.

Let us provide a customized employee experience for you! We encourage teambuilding, collaboration, and creating a fulfilling work life. You don’t need prior experience if you are ambitious, hardworking, and dedicated. Come join our evolved workplace where we embrace physical wellbeing, a positive vibe, meaningful work, and happiness. Kind, caring people who want to be part of an INSPIRED team. Come learn with us - you'll love it!

WHO

Are you a detail-oriented healthcare support professional who thrives in a dynamic environment? Western Nephrology is seeking a dedicated team member to support our clinic operations through prior authorizations, specialty referrals, and patient scheduling. In this vital role, you will serve as a bridge between patients, clinical care teams, and insurance carriers—ensuring our nephrology patients receive seamless, timely care while navigating complex insurance processes.

WHAT DO I GET?

Competitive compensation package includes medical, dental, vision, life, long term disability, health savings account, 401k retirement with generous matches, paid holidays, PTO and a cash out option after one year of employment, pet insurance, maternity/paternity leave, and our discount marketplace. We also offer multiple mental health resources including free EAP counseling sessions, access to Ginger®, and Talkspace®

WHAT WILL I DO?

Prior Authorizations & Referrals: Submit, track, and obtain prior authorizations and referrals for new and established patients; actively review databases to ensure all approvals are secured prior to appointment dates.

Clinic & Billing Collaboration: Partner closely with clinic staff, providers, and billing teams to ensure authorization accuracy, communicate approval/denial statuses, and minimize claim denials.

Patient Financial Navigation: Clearly answer patient inquiries regarding copays, deductibles, patient-responsible portions, and write-offs.

Records & Administration: Process third-party medical record requests efficiently while maintaining strict compliance with HIPAA guidelines.

MUST HAVES

2 years handling provider referrals and prior authorizations in a specialty care setting.

IT’S A PLUS IF YOU HAVE THIS!

Solid understanding of commercial and government insurance carrier procedures, medical terminology, and HIPAA regulations.

Demonstrated ability to assess complex situations, anticipate issues, and prioritize urgent patient appointments.

Excellent written and verbal communication skills with an emphasis on active listening, empathy, and exceptional customer service.

Proven ability to multitask and complete high-volume assignments independently while maintaining a strong team-player mindset.

OTHER STUFF!

Pay Range $21.00 - $23.50
Western Nephrology is a DRUG FREE WORKPLACE and an Equal Opportunity Employer. We provide equal employment opportunity to all qualified individuals regardless of race, color, religion, sex, age, national origin, citizenship, veteran status, disability, sexual orientation, gender identity, genetic information, or any other factor protected by applicable federal, state or local law.

Western Nephrology, the premier Nephrology practice in the Denver Metropolitan area, began business in 1968 caring for people with kidney disorders. Today, Western Nephrology provides consultative services at numerous hospitals along the Front Range communities. The practice is comprised of 14 board certified Nephrologists at 5 clinics treating patients for a variety of nephrological conditions including acute kidney injury, hypertension, chronic kidney disease and End Stage Renal Disease. In addition to their hospital work, its providers and staff care for patients at nephrology clinics, dialysis clinics and rehabilitation centers.