Strategic Healthcare Referral & Authorization Specialist

Care New England; Warwick (RI); On-site; USD 42,000 - 65,000; Full time

Job summary

Care New England is seeking a Referral and Authorization Specialist to oversee referrals and prior authorizations for specialty visits and outpatient testing. The role centralizes and streamlines authorization workflows to reduce denials and improve payer compliance, patient experience, and financial outcomes.

You will verify insurance information, communicate with internal teams via the EHR, and support CNEMG PCPs with external referral submissions.

Qualifications

• 5–7 years of healthcare experience.
• 3 years of experience processing insurance referrals and prior authorizations.
• Bilingual abilities preferred.

Responsibilities

• Request and obtain referrals and prior authorizations and track status in the EHR.
• Evaluate payer policies to understand authorization requirements.
• Communicate request status with internal offices via the EHR.
• Verify accuracy of patient insurance information for referrals/authorizations.
• Explain Notices of Non-Covered Services and waivers to patients.
• Manage external referral process for CNEMG PCPs and provide documentation.
• Monitor EHR inbox and in-basket pools during the day.

Skills

Referral & authorization processing

Healthcare experience

Bilingual preferred

Communication skills

HIPAA knowledge

Education

High School Diploma or GED

Associate degree preferred

Medical Assistant certification/registration preferred

Tools

EPIC EHR

Microsoft 365

Job description

Care New England is seeking a Referral and Authorization Specialist to oversee referrals and prior authorizations for specialty visits and outpatient testing. The role centralizes and streamlines authorization workflows to reduce denials and improve payer compliance, patient experience, and financial outcomes.

You will verify insurance information, communicate with internal teams via the EHR, and support CNEMG PCPs with external referral submissions.