TEKsystems-posted about 5 hours ago
$18 - $20/Yr
Full-time • Mid Level
Remote • Phoenix, AZ
5,001-10,000 employees

The Referral and Authorization specialist is responsible for ensuring patients have been cleared for specialty service office visits; obtaining and issuing referrals for ancillary, consult, radiology or lab visits; receiving approvals for medication formularies, durable medical equipment, home health care and other items or services needed. Answer and place high-volume inbound and outbound calls (80+ daily) via auto-dialer to assist members with referral and scheduling needs Review and verify insurance benefits, ensuring patients are scheduled with appropriate specialists within the Medical Group network Generate and process 25+ referrals daily from Primary Care Physicians, maintaining accuracy and timeliness in documentation Collaborate with care coordinators, medical offices, and provider networks to support seamless transitions of care and follow-up Help members choose PCPs and specialists, transfer medical records, and handle various care navigation tasks with empathy and efficiency Research and resolve member or provider questions with thorough follow-up, ensuring a high standard of service and satisfaction Prioritize referrals across diverse specialties such as Surgical, OBGYN, Pediatrics, Radiology, Physical Therapy, Internal Medicine, and Orthopedics

  • ensuring patients have been cleared for specialty service office visits
  • obtaining and issuing referrals for ancillary, consult, radiology or lab visits
  • receiving approvals for medication formularies, durable medical equipment, home health care and other items or services needed
  • Answer and place high-volume inbound and outbound calls (80+ daily) via auto-dialer to assist members with referral and scheduling needs
  • Review and verify insurance benefits, ensuring patients are scheduled with appropriate specialists within the Medical Group network
  • Generate and process 25+ referrals daily from Primary Care Physicians, maintaining accuracy and timeliness in documentation
  • Collaborate with care coordinators, medical offices, and provider networks to support seamless transitions of care and follow-up
  • Help members choose PCPs and specialists, transfer medical records, and handle various care navigation tasks with empathy and efficiency
  • Research and resolve member or provider questions with thorough follow-up, ensuring a high standard of service and satisfaction
  • Prioritize referrals across diverse specialties such as Surgical, OBGYN, Pediatrics, Radiology, Physical Therapy, Internal Medicine, and Orthopedics
  • 2+ years healthcare experience, specialty referral experience, and outside of pharmacy referrals
  • MA if possible or healthcare benefits experience.
  • Call center experience is a plus!
  • High school diploma or equivalent (GED
  • Excellent listening skills required.
  • Must possess the ability to work independently with strong organizational, communication and interpersonal skills to support the management of multiple priorities with significant attention to detail for project completion.
  • Medical, dental & vision
  • Critical Illness, Accident, and Hospital
  • 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available
  • Life Insurance (Voluntary Life & AD&D for the employee and dependents)
  • Short and long-term disability
  • Health Spending Account (HSA)
  • Transportation benefits
  • Employee Assistance Program
  • Time Off/Leave (PTO, Vacation or Sick Leave)
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