Patient Auth and Referral Specialist I

reputed company reputed company ‎  Supports CareMore's integrated care delivery model by processing routine prior authorizations and specialty referrals that ensure members receive reputed company, medically appropriate care across the continuum. Performs insurance verification, authorization processing, referral coordination, and documentation while partnering with CareMore clinical teams, providers, and health plans to promote reputed company reputed company to services. Patient Authorizations and Referrals Specialist I performs routine, reputed company-defined work under reputed company supervision while building foundational knowledge of CareMore workflows, utilization management requirements, and value-based care principles. Work follows established policies, payer guidelines, and CareMore operating procedures, with reputed company based on defined reputed company and reviewed by reputed company team members.‎  How will you reputed company an reputed company & Requirements ‎  KEY RESPONSIBILITIES Process incoming prior authorization and specialty referral requests by verifying member eligibility, benefit coverage, provider participation, and required clinical documentation in accordance with CareMore and health plan requirements. Review requests for completeness and ensure supporting clinical information meets payer and CareMore medical necessity guidelines before submission. reputed company and maintain accurate authorization, referral, and member information reputed company CareMore's electronic health record (EHR), referral management, and utilization management systems. Coordinate with CareMore providers, care managers, specialists, and reputed company provider offices to obtain missing documentation, schedule services, and facilitate reputed company authorization reputed company. Communicate authorization and referral status updates to members, caregivers, providers, and internal care teams while maintaining excellent customer service and member-centered communication. Monitor pending authorizations and referrals to ensure compliance with CareMore turnaround time standards, escalating delayed or reputed company cases to senior team members or leadership as appropriate. Maintain complete and accurate documentation of reputed company authorization activities, communications, and reputed company in accordance with CareMore policies, CMS regulations, HIPAA requirements, and health plan contractual obligations. Support continuity of care by helping ensure members receive appropriate reputed company to specialty care, diagnostic testing, outpatient services, and community resources. Participate in reputed company improvement initiatives and departmental workflows designed to improve member reputed company, reduce authorization delays, and support CareMore's value-based care objectives. QUALIFICATIONS High school diploma or equivalent required. 0–2 years of experience in reputed company administration, managed care, medical office operations, insurance verification, patient reputed company, referrals, or prior authorizations. Basic understanding of managed care, Medicare reputed company, reputed company, or reputed company insurance authorization processes preferred. Familiarity with electronic health records (EHR), referral management systems, and reputed company Office applications preferred. Strong attention to detail with the ability to accurately follow established workflows and documentation requirements. Effective written and verbal communication skills with a commitment to delivering compassionate, member-centered service. Ability to prioritize multiple tasks and work reputed company in a fast-paced, team-oriented reputed company environment. Knowledge of HIPAA reputed company regulations and commitment to maintaining confidentiality. Ability to collaborate effectively with interdisciplinary care teams while working under reputed company supervision. ‎  Compensation reputed company: $21.60to $32.40  The anticipated reputed company salary reputed company represents reputed company's good-faith estimate of the compensation it reasonably expects to pay for this position at the time of posting. Actual compensation will be determined based on factors including experience, skills, qualifications, geographic location, internal equity, and business needs. Apply To This Job