Job Description: Referral / Authorization Processor
Position Type: Contract to Permanent
Pay Rate: $22/hr + Various Benefits Plans offered with employer and employee contribution
Work Schedule: 100% Remote (Must work Pacific Time zone hours)
Location Requirements: No specific location requirements
Licensure Requirements: None
Schedules Available
- Tuesday - Saturday
- Sunday - Thursday
- Flexible schedule including both Saturday and Sunday (e.g., Wednesday - Sunday, Thursday - Monday, etc.) Working hours for all schedules: 8:30 AM - 5:00 PM (with a 30-minute lunch break)
Position Overview
The Referral / Authorization Processor will work as part of the Care Access and Monitoring (CAM) team within a Managed Care Organization. This role involves processing referrals and authorizations, primarily supporting IP non-clinical teams. The processor will manage faxes, verify patient information, assist with inpatient status confirmations, and provide data entry support. The role requires a strong knowledge of medical terminology, prior authorization experience, and proficiency in working with ICD-10 and CPT codes.
Responsibilities
- Process provider requests received via fax and build authorizations.
- Communicate with providers, answering calls and resolving inquiries.
- Verify member eligibility, benefits, and determine diagnosis and treatment requests.
- Assign appropriate billing codes (ICD-10, CPT/HCPC codes).
- Confirm inpatient hospital admissions and discharges, update census, and verify facility and IPA contact details.
- Assist with custodial care referrals and escalate to the appropriate team members.
- Provide excellent customer service to both internal and external clients.
- Collaborate with the Care Access and Monitoring team to ensure quality and cost-effective healthcare services.
- Maintain compliance with HIPAA and company confidentiality standards.
- Meet productivity, quality review, and attendance standards as required.
Knowledge/Skills/Abilities
- Experience with prior authorizations, utilization review, and medical terminology.
- Ability to work effectively in a fast-paced environment, independently and as part of a team.
- Strong problem-solving and analytical skills.
- Excellent communication and customer service skills.
- Proficiency in data entry and Microsoft Office applications.
- Ability to enter data accurately at a minimum of 40 words per minute.
Education And Experience Requirements
- High School Diploma/GED required.
- 2-4 years of experience in a Utilization Review Department in a Managed Care Environment.
- Previous experience in healthcare clerical, audit, or billing roles.
- Knowledge of medical terminology and prior experience in a hospital or healthcare setting.