Referrals & Authorizations Rep

Kidney Specialists Of Southern Nevada; Las Vegas (NV); On-site; USD 42,000 - 52,000; Full time

Benefits offered by this job

Company-paid holidays

Medical

Dental

Vision

Paid Time Off

Company-paid Life Insurance

Company-paid Short-term Disability

Company-paid Long-term Disability

401(k)

Job summary

Kidney Specialists of Southern Nevada (KSOSN) seeks a Referrals and Authorization Representative to coordinate patient services, verify eligibility, ensure insurance coverage, and determine if prior authorization is needed. You will work with patients, carriers, and providers, manage referrals and authorizations, document in the electronic health record, and help streamline workflows to support patient care across our team.

This role supports a collaborative environment across eight locations.

Qualifications

• Minimum two (2) years of related experience required.
• Knowledge and appropriate use of medical terminology required.
• Must have excellent communication and computer skills.
• Prior experience working in an urgent care or specialty setting preferred.

Responsibilities

• Serves as the primary liaison for all referrals and authorizations needed 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 including prior authorizations for all medication and office visits.
• 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.
• Other duties as assigned

Skills

Medical terminology

Communication skills

Computer skills

Job description

Job Details: Job Location: Central HQ - Las Vegas, NV 89146, Position Type: Full Time, Job Shift: Mon - Th 7:30am to 5pm & Fri 8am to 12 n, Job Category: Health Care, Kidney Specialists of Southern Nevada (KSOSN) provides comprehensive kidney care and a full spectrum of kidney disease management resources for residents of Southern Nevada. Our care team educates and empowers patients who are living with kidney pain, infections, stones, and other kidney problems. With this exciting opportunity you will be joining a seasoned team of 65 Physicians, Nurse Practitioners, and Physicians Assistants, as well as 130+ team members across eight locations. We are looking for a dynamic Referrals and Authorizations Representative to join our growing team.

Position Summary

The Referral and Authorization Representative is responsible for the coordination of patient services, including referrals and authorizations. The primary purpose for this position is to perform the appropriate processes to verify patient eligibility, ensure insurance coverage, and determine if prior authorization is needed. The Referral and Authorization Representative will be committed to creating a quality environment, promoting the patient experience and patient safety, creating an exceptional work experience for our KSOSN team and patients. The Referral and Authorization Representative will partner with the leadership team to achieve KSOSNs goals.

Essential Job Functions

• Serves as the primary liaison for all referrals and authorizations needed 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 including prior authorizations for all medication and office visits
• 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
• Other duties as assigned

Benefits

• Company-paid holidays
• Medical
• Dental
• Vision
• Paid Time Off
• Company-paid Life Insurance
• Company-paid Short-term Disability
• Company-paid Long-term Disability
• 401(k)

Qualifications: Minimum Requirements

• Minimum two (2) years of related experience required.
• Knowledge and appropriate use of medical terminology required.
• Must have excellent communication and computer skills.
• Prior experience working in an urgent care or specialty setting preferred.