Responsible for obtaining insurance authorizations, processing referrals, and verifying referral and precertification requirements for patient services. This role supports timely patient care and accurate reimbursement by ensuring that referrals, diagnostic testing, procedures, medications, imaging, and specialist visits meet insurance requirements.
Also responsible for coordinating peer-to-peer reviews, assisting with appeals or additional clinical documentation when needed, maintaining referral and authorization records, and communicating delays or denials to the appropriate staff.
Requirements & Qualifications
Qualifications
- Previous experience in medical office administration, referrals, precertification, prior authorizations, or insurance verification preferred
- Knowledge of medical terminology, insurance benefits, and payer authorization requirements
- Familiarity with CPT and ICD-10 codes preferred
- Experience with eClinicalWorks or another EHR system preferred
- Proficiency with insurance portals, Microsoft Office, fax systems, and electronic communication
- Strong organizational, communication, and follow-up skills
- Ability to manage multiple requests, prioritize deadlines, and work independently
- Attention to detail and commitment to patient confidentiality
Performance expectations
- Process referrals and authorization requests accurately and within established timeframes
- Follow up consistently on pending requests
- Maintain complete and accurate documentation in the electronic health record
- Identify potential authorization or referral issues before scheduled services whenever possible
- Communicate delays, denials, and missing information promptly
- Minimize preventable scheduling delays and claim denials related to missing referrals or authorizations
Benefits & Perks
Benefits
- 401(k)
- 401(k) matching
- Dental insurance
- Disability insurance
- Flexible spending account
- Health insurance
- Health savings account
- Life insurance
- Paid time off
- Vision insurance
Location
New Jersey, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
No
Posted
3 weeks ago