Strategic Referral & Authorization Lead

Butler; Warwick (RI); On-site; USD 48,000 - 68,000; Full time

Job summary

Care New England Health System is seeking a Referral and Authorization Specialist to oversee referrals and authorizations for specialty visits and outpatient testing. This role centralizes and streamlines the authorization workflow to improve operational efficiency, patient experience, and financial performance.

The specialist ensures timely, accurate authorization information before services, reducing denials, ensuring payer compliance, and optimizing reimbursement while supporting care

Qualifications

• High School or GED required.
• Associate degree or Certified/Registered Medical Assistant preferred.

Responsibilities

• Request and obtain insurance referrals and prior authorizations via carriers or third-party vendors and track status in the EHR.
• Evaluate payer policies for authorization and admission notice requirements.
• Communicate referral/authorization status with internal offices via the EHR.
• Document all work related to referrals and authorizations in the EHR.
• Coordinate with internal and external offices to obtain necessary information for approvals.
• Verify patient insurance information to secure referrals/authorizations.
• Notify about issues with referrals/authorizations to relevant departments.
• Explain waiver notices to patients as needed.
• Manage external referral processes for CNEMG PCPs including submissions and documentation.
• Monitor EHR queues and in-basket pools during the day.

Skills

Bilingual

Effective communication

Customer service

Education

High School Diploma or GED

Associate degree or Certified/Registered Medical Assistant

Tools

EPIC EHR

Microsoft 365

Job description

Care New England Health System is seeking a Referral and Authorization Specialist to oversee referrals and authorizations for specialty visits and outpatient testing. This role centralizes and streamlines the authorization workflow to improve operational efficiency, patient experience, and financial performance.

The specialist ensures timely, accurate authorization information before services, reducing denials, ensuring payer compliance, and optimizing reimbursement while supporting care