Referral Specialist

Title: Referral Specialist 1 (Prior-Authorization Specialist)

Location: REMOTE - IA

Duration: 3 months contract

Target Start Date: 2/19/2024

Shift: 8:00 AM - 5:00 PM CST - Tuesday - Saturday

Training Schedule: 8:00 AM - 5:00 PM CST - Monday - Friday

Job Description:

• Supports the prior authorization request to ensure all authorization requests are addressed properly and in the contractual timeline. Aids utilization management team to document authorization requests and obtain accurate and timely documentation for services related to the member's healthcare eligibility and access.
• Supports authorization requests for services following the insurance prior authorization list

Responsibilities:

• Supports and performs data entry to maintain and update authorization requests in the utilization management system
• Assists the utilization management team with ongoing tracking and appropriate documentation on authorizations and referrals following policies and guidelines
• Contributes to the authorization review process by documenting necessary medical information such as history, diagnosis, and prognosis based on the referral to the clinical reviewer for determination
• Remains up-to-date on healthcare, authorization processes, policies and procedures
• Performs other duties as assigned. Complies with all policies and standards

Required Skills/Experience/Education:

• 2 years of Referral or Prior-Authorization Medical Information Experience. Preferred Medical Auth Building Experience
• Good phone skills and customer service, team player.
• Strong Typing Skills, Microsoft Office Skills (Excel, Word, Outlook), and Multitasking skills navigating multiple systems/monitors.
• Knowledge of medical terminology and medical records retrieval preferred
• High School Diploma or GED required.
• Must send typing test result (typingtest.com) and Internet Speed Test (speedtest.net)

Job Type: Contract

Salary: $19.00 per hour

Expected hours: No less than 40 per week

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Flexible schedule
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Weekly day range:

• Weekends as needed

Experience:

• Health Insurance Verification: 2 years (Required)
• Prior-Authorization: 2 years (Required)

Ability to Commute:

• West Des Moines, IA 50266 (Required)

Ability to Relocate:

• West Des Moines, IA 50266: Relocate before starting work (Required)

Work Location: Remote