Referral Authorization Specialist

Lifepoint Health • Hancock, MI

4h • Onsite

About The Position

UP Health System - Portage, part of Lifepoint Health, is seeking a Referral Authorization Specialist. This role is crucial in prioritizing patient well-being and providing exceptional care by managing pre-authorizations for various medical services. The specialist will ensure timely processing of diagnostic testing, therapy, surgical, and specialty care appointments according to insurance requirements, communicate with patients and providers, and maintain up-to-date knowledge of healthcare plans. The position also involves resolving patient barriers to specialty care, tracking high-priority referrals, and assisting with administrative duties.

Requirements

• High School Diploma or Equivalent Required.
• Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision.
• Must be able to work in a stressful environment and take appropriate action.

Nice To Haves

• Associates Degree preferred.
• 2 years Medical Office experience Preferred.
• Experience with Medical Referrals Preferred

Responsibilities

• Completes pre-authorizations for all diagnostic testing, therapy, surgical and specialty care appointments according to insurance requirements within 3 days of issuance.
• Notifies patient when referral is approved and notifies Provider if denied or if a second opinion or additional information is required.
• All communication with patient, nurse, and/or Provider will be documented in the clinic EMR.
• Updates to referrals will be made in the EMR each time communication is had with patient, insurance provider, nurse, or Provider.
• Maintains up-to-date knowledge of all health care plans and interprets and communicates plan policies and procedures to employees, physicians and (patients) when they have changed.
• Identifies and attempts to resolves patient’s barriers to specialty care, including assisting with scheduling appointments and helping to coordinate with specialist offices.
• Assists in tracking high-priority referrals to ensure patients in high-risk categories receive necessary follow up care.
• Under the supervision of physician or nurse, assists with performing patient assessments and treatments.
• Performs administrative or clerical duties as assigned, including filing, reception, scheduling, data entry, and patient registration.

Benefits

• Comprehensive Benefits: Multiple levels of medical, dental and vision coverage for full-time and part-time employees.
• Financial Protection & PTO: Life, accident, critical illness, hospital indemnity insurance, short- and long-term disability, paid family leave and paid time off.
• Financial & Career Growth: Higher education and certification tuition assistance, loan assistance and 401(k) retirement package and company match.
• Employee Well-being: Mental, physical, and financial wellness programs (free gym memberships, virtual care appointments, mental health services and discount programs).
• Professional Development: Ongoing learning and career advancement opportunities.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED