Referral & Prior Authorization Specialist

Kidney-Specialists-of-Southern-Nevad; Las Vegas (NV); On-site; USD 42,000 - 65,000; Full time

Benefits offered by this job

Medical

Dental

Vision

Paid Time Off

Company-paid Holidays

Life Insurance

Short-term Disability

Long-term Disability

401(k)

Job summary

Kidney Specialists of Southern Nevada (KSOSN) is seeking a Referrals and Authorizations Representative to coordinate patient referrals and prior authorizations. This role ensures eligibility, insurance coverage, and timely authorization processing for KSOSN patients.

You will work with patients, insurance carriers, and providers, maintaining accurate records and advocacy to facilitate approvals while supporting a quality patient experience across multiple locations.

Qualifications

• Minimum two years of related experience.
• Knowledge and appropriate use of medical terminology.
• Excellent communication and computer skills.
• Prior experience in an urgent care or specialty setting preferred.

Responsibilities

• Serves as the primary liaison for all referrals and authorizations for KSOSN patients.
• Facilitates communication between patients, insurance carriers, and providers.
• Processes and schedules internal and external referrals; submits medical records to insurance carriers to expedite prior authorization processes.
• Requests, tracks, and obtains prior authorizations both in/out of network and internal/external from insurance carriers and third-party authorization companies.
• Maintains ongoing tracking and appropriate documentation on referrals and prior authorizations in internal and external systems.
• Develops and implements prior authorization and referral work flow, policies and procedures.
• Manages correspondence with insurance companies, physicians, specialists and patients.
• Develops and maintains relationships with all insurance carriers, representatives, and referral sources.
• Remains current on insurance changes.
• Assumes advocate role on the patient's behalf with the carrier to ensure approval of authorization in a timely manner.
• Maintains documentation in the electronic health record.

Skills

Excellent communication

Computer skills

Medical terminology

Job description

Kidney Specialists of Southern Nevada (KSOSN) is seeking a Referrals and Authorizations Representative to coordinate patient referrals and prior authorizations. This role ensures eligibility, insurance coverage, and timely authorization processing for KSOSN patients.

You will work with patients, insurance carriers, and providers, maintaining accurate records and advocacy to facilitate approvals while supporting a quality patient experience across multiple locations.