Referral & Prior Authorization Specialist

Providence Community Health; Providence (RI); On-site; USD 40,000 - 60,000; Full time

Job summary

Providence Community Health is seeking a Referral Coordinator to support physicians, practitioners, and care teams in coordinating referrals and authorizations. You will review requests, expedite referrals, and communicate necessary information to ensure timely patient care.

The role requires strong communication, attention to detail, and knowledge of HIPAA compliance. Experience with ambulatory care and EHR systems is preferred, with a commitment to compassionate patient service.

Qualifications

• Minimum of an Associate's Degree and/or completion of a medical training program.
• Experience in ambulatory care centers is preferred.
• Proficiency with medical terminology and HIPAA regulations is expected.

Responsibilities

• Coordinate referrals and diagnostic imaging prior authorizations.
• Review referrals for completeness and communicate requirements to care teams.
• Act as liaison between insurance carriers and care teams to facilitate approvals.
• Maintain awareness of insurance plan coverage and network specialists.

Skills

Communication skills

Independent worker

Attention to detail

Medical terminology

HIPAA compliance

Team collaboration

Customer service

Education

Associate's degree or medical training program

Tools

Microsoft Office

EHR system (PCHC)

Job description

Providence Community Health is seeking a Referral Coordinator to support physicians, practitioners, and care teams in coordinating referrals and authorizations. You will review requests, expedite referrals, and communicate necessary information to ensure timely patient care.

The role requires strong communication, attention to detail, and knowledge of HIPAA compliance. Experience with ambulatory care and EHR systems is preferred, with a commitment to compassionate patient service.