Referral & Pre-Authorization Specialist

Hollister Incorporated; Mount Juliet (TN); On-site; USD 42,000 - 56,000; Full time

Benefits offered by this job

Medical coverage

401k

Paid time off

EAP

Employee discounts

Job summary

ABC Medical seeks a Referral Specialist to verify and process medical documentation from physicians and referral sources, ensuring local coverage determinations and regulatory requirements are met, and handling pre-authorizations. You will contact insurers, update databases, communicate with providers, payors, and sales managers, and strive to meet service level agreements while adhering to HIPAA.

The role offers a Monday-Friday schedule, with standard daytime hours in local time, and a benefits

Qualifications

• High School Diploma or equivalent.
• 2+ years of work experience.
• Basic understanding of payor guidelines.
• Analytical skills required, attention to detail, and organized.
• Basic Microsoft skills.
• Ability to work well in a team environment.

Responsibilities

• Verify, obtain, review, and determine that documentation meets local coverage determinations and regulatory requirements.
• Handle pre-authorization functionality and communicate with payors.
• Examine documents for compliance, completeness, and data accuracy.
• Confer with originators/approvers to resolve discrepancies.
• Contact insurance companies to confirm coverage and eligibility.
• Obtain prior authorization and/or referrals.
• Update customer databases and files with new documents and pre-authorizations.
• Generate communications regarding new or revised documents, including pre-authorization requests.
• Regularly communicate with health care providers, payors, and sales managers.
• Aim to achieve defined service level agreements.
• Adhere to HIPAA guidelines/regulations.

Skills

Analytical skills

Attention to detail

Organized

Microsoft Office

Team player

Payor guidelines understanding

Education

High School Diploma or equivalent

Tools

Microsoft Office

Job description

ABC Medical seeks a Referral Specialist to verify and process medical documentation from physicians and referral sources, ensuring local coverage determinations and regulatory requirements are met, and handling pre-authorizations. You will contact insurers, update databases, communicate with providers, payors, and sales managers, and strive to meet service level agreements while adhering to HIPAA.

The role offers a Monday-Friday schedule, with standard daytime hours in local time, and a benefits