Referral & Pre-Authorization Specialist

ABC Medical, Inc.; Mount Juliet (TN); On-site; USD 38,000 - 46,000; Full time

Benefits offered by this job

Variety of Medical, Dental and Vision

401k Plan with Company Match

PTO and Paid Holidays

EAP

Employee Discounts

Job summary

ABC Home Medical Supply, Inc is a leading urological supply provider delivering a comprehensive line of medical supplies and services, including urological, incontinence, wound care, and ostomy products. The Referral Specialist will verify documentation meets regulatory requirements and manage pre-authorization processes.

This on-site role in Nashville requires 2+ years of experience, strong attention to detail, teamwork, and basic Microsoft skills, with responsibilities spanning insurer

Qualifications

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

Responsibilities

• Verify and determine that documentation meets local coverage determinations and regulatory requirements.
• Perform pre-authorization tasks and refer to applicable processes.
• Examine documents for completeness and accuracy of data.
• Confer with document originator and approvers to resolve discrepancies.
• Contact insurance companies to confirm coverage and eligibility of products.
• Obtain prior authorization and/or referrals.
• Update customer databases and files accordingly.
• Generate communications to appropriate personnel regarding pre-authorization requests.
• Communicate with Health Care Providers, Payors, and Sales Managers regularly.
• Achieve defined service level agreements.
• Adhere to HIPAA guidelines/regulations.

Skills

Attention to detail

Analytical skills

Teamwork

Communication skills

Education

High School Diploma or equivalent

Tools

Microsoft Office

Job description

ABC Home Medical Supply, Inc is a leading urological supply provider delivering a comprehensive line of medical supplies and services, including urological, incontinence, wound care, and ostomy products. The Referral Specialist will verify documentation meets regulatory requirements and manage pre-authorization processes.

This on-site role in Nashville requires 2+ years of experience, strong attention to detail, teamwork, and basic Microsoft skills, with responsibilities spanning insurer