Referral And Authorization Specialist

TEKsystems•Boulder City, NV

1d•Remote

About The Position

The Referral and Authorization Specialist ensures patients are cleared for specialty medical services by coordinating referrals, authorizations, and approvals across complex healthcare services. This role supports specialty care access while maintaining compliance, accuracy, and patient confidentiality.

Requirements

2+ years of healthcare experience, preferably in: Specialty referrals, Prior authorization, Patient registration or scheduling
Experience in a medical office or healthcare environment
Strong knowledge of: Medical terminology, Insurance verification and benefits, Referral processing and authorization workflows
High School Diploma or GED required
Excellent listening, communication, and interpersonal skills
Ability to work independently with strong organization and time management skills

Nice To Haves

Medical Assistant (MA) certification
Experience with healthcare benefits outside of pharmacy-only referrals
Call center experience
Prior exposure to complex or specialty medical services

Responsibilities

Coordinate and process referrals for specialty, ancillary, consult, radiology, and laboratory services
Obtain authorizations and approvals for: Specialty office visits, Medications (formulary-related), Durable Medical Equipment (DME), Home health services and other medical needs
Verify insurance eligibility, benefits, and authorization requirements
Collaborate with providers, payers, and patients to resolve authorization issues
Document referral and authorization activity accurately within medical systems
Support Complex Specialty Medical Services, requiring strong medical terminology knowledge
Maintain strict adherence to HIPAA and patient confidentiality standards
Manage multiple priorities independently with strong attention to detail