Remote Authorization & Referrals Specialist III

61st Street Service Corporation; United States; Remote; USD 40,000 - 51,000; Full time

Benefits offered by this job

Healthcare benefits

Paid time off

Job summary

The 61st Street Service Corporation, which provides administrative and clinical support for ColumbiaDoctors, invites applications for an Authorization & Referrals Specialist III. This full-time role is primarily remote, with preference for candidates living in the Tri-State area.

You will verify insurance benefits, secure pre-authorizations, and manage referrals, while training staff and assisting with audits.

Qualifications

• High school graduate or GED required.
• Minimum 2 years’ experience in a physician billing or third payer environment.
• Ability to understand managed care eligibility and insurance billing requirements.
• CPC certification preferred.
• Experience in Epic or other electronic billing systems preferred.
• Knowledge of medical terminology, diagnosis and procedure coding preferred.
• Experience in an academic healthcare setting preferred.

Responsibilities

• Verifies insurance coverage via system tools.
• Confirms provider participation status with patient’s insurance plan/network.
• Determines payer referral and authorization requirements for professional services.
• Contacts patient and PCP to secure payer required referral for planned services.
• Documents referral in practice management system.
• Initiates authorization and submits clinical documentation as requested by insurance companies.
• Manage faxes, emails, and phone calls in a timely manner.
• Communicates with surgical coordinators regarding authorizations status or denials.
• Submits appeals in the event of denial of prior authorizations or denial of payment following procedures.
• Calculate and document patient out of pocket estimates and provide to patient.
• Assists Supervisor with special projects and/or tasks.
• Assists Authorization-Referrals Specialist I and II with complex cases pertaining to clearance of payer referrals, authorization or insurance eligibility issues.
• Assist supervisor/manager with distribution of daily work assignments.
• Assist with new-hire training and staff refresher training materials.
• Monitor and replenish the unit’s office supply needs.
• Performs other job duties as assigned.

Skills

Medical billing experience

Pre-authorization knowledge

Epic experience

Education

High school diploma or GED

Tools

Epic

Job description

The 61st Street Service Corporation, which provides administrative and clinical support for ColumbiaDoctors, invites applications for an Authorization & Referrals Specialist III. This full-time role is primarily remote, with preference for candidates living in the Tri-State area.

You will verify insurance benefits, secure pre-authorizations, and manage referrals, while training staff and assisting with audits.