Referral & Authorization Coordinator

Medical Insurance Authorization SpecialistWe are looking for an energetic, hard-working, dependable, multi-tasking Medical Insurance Authorization Specialist who is passionate about helping others and making a difference.The Authorization Specialist completes authorizations and referrals for our medical services. In addition to reviewing the medical history of potential patients, verifies information provided by referring physicians and verifies insurance coverage. Also monitors the schedule for add-on patients, ensuring there are no conflicts and we have the prior authorization needed to move forward with appointment or procedure.Duties and Responsibilities:Verifies information provided by referring physicians and verifies insurance coverage.Analyze patient records and insurance policies to determine if procedures, treatments, or medications require prior authorizationEnsure patients are eligible for services and that insurance benefits are accurateInteracts with healthcare providers, insurance companies, and patients to obtain and provide information needed for authorization decisionsNotify providers of potential coverage optionsCommunicate with patients about the authorization process and any potential delays or financial implications.May suggest formulary/cheaper alternatives for expensive drugs.May investigate any serious drug interactions with the requested drug.Completes authorizations and referrals for our medical services, including appointments and procedures.Input new patient information and update information in our systemCompile and submit detailed authorization requests to insurance companies, including all necessary documentationResearch and resolve any issues or discrepancies related to authorization requestsMonitor and follow up on authorization requests to ensure timely processingInvestigate insurance denials and resubmit requests or appeal when necessary.Complete billing documentationMonitors the schedule for add-on patients, ensuring no conflicts, and we have required prior authorization to move forward with appointment or procedure.Remain informed about healthcare industry regulations, trends and insurance policiesAssist with other clerical tasks as needed and perform other related duties as assigned by management.Qualifications:High school diploma or general education degree (GED), or one to three months related experience and/or training, or equivalent combination of education and experience.

Associate degree a plus.Some experience in medical billing or insurance authorization (strongly preferred).Knowledge of medical terminology.Basic computer skills.Attention to detail.Job Type / Work Schedule:This is a full-time position, in-office positionStandard office hours, Monday - Friday 8:00 AM - 4:30 PMBilingual RequiredCompetitive pay and full benefits package, including 401(k), health, dental, vision, life, and disability insurance.