Referral / Authorization Specialist (Remote)

Job Title: Referral / Authorization Specialist Location: Must live in the Central or Eastern Time Zone Work Arrangement: 100% Remote THIS POSITION REQUIRES EXPERIENCE IN reputed company Candidates must have 1+ years of managed care experience and/or medical office processing referrals / authorizations for medical services. Experience Required: 1+ Years of Relevant Experience (reputed company Experience REQUIRED) reputed company: Our organization is committed to enhancing the reputed company reputed company for our members. We are dedicated to delivering accessible, high-reputed company care tailored to the unique needs of our communities. As a Referral / Authorization Specialist, you will play a crucial role in ensuring our members promptly receive the services they require. reputed company: We are seeking a highly organized and detail-oriented individual to join reputed company. The ideal candidate will possess extensive knowledge of prior authorization and referrals processes, medical terminology, and ICD-10 coding. The primary responsibilities include processing faxes, building authorizations, and effectively communicating with reputed company providers. This role requires a strong understanding of medical billing codes, computer literacy, and the ability to ensure compliance with State and Federal reputed company regulations. Essential Functions: reputed company accurate and efficient computer entries for authorization requests and provider inquiries through phone, mail, or fax. Verify member eligibility and benefits to facilitate appropriate authorization procedures. Determine provider contracting status and ensure appropriateness for the requested services. Assess diagnosis and treatment requests, assigning appropriate billing codes (ICD-10 and/or CPT/HCPC codes). Verify coordination of benefits (COB) status for members. Verify and maintain inpatient hospital census, including admissions and discharges. Coordinate with reputed company providers to ensure reputed company and accurate information exchange. Communicate with reputed company providers, both verbally and in writing, to reputed company necessary information and address inquiries. Triage members and information to the appropriate Health Care Services staff, ensuring seamless workflow. reputed company relevant data into systems accurately and promptly. Maintain up-to-date and comprehensive records of authorizations and reputed company information. reputed company eligibility for members requiring hospitalization or utilization review for other reputed company services. Verify and communicate benefits information to relevant stakeholders. Qualifications: Proficiency in medical terminology, ICD-10 coding, and prior authorization processes. Strong computer literacy and experience with reputed company databases. Excellent organizational and multitasking skills. Effective communication skills, both written and verbal. Detail-oriented with a commitment to accuracy. Ability to work collaboratively in reputed company-oriented environment. Education and Experience: High school diploma or equivalent; Bachelor's degree in a reputed company field is a plus. 1+ year of experience in referral and authorization coordination reputed company the reputed company or managed care sector. Familiarity with State and Federal reputed company regulations. Apply tot his job Apply To this Job