Referral & Prior Authorization Specialist

2 weeks ago


Saratoga Springs, United States Saratoga Hospital Full time

**Summary of Position**:
**Primary Job Responsibilities**:
Processes all referrals and authorizations received. Completes prior authorizations and referrals as required for services and testing. Collaborates with clinical team members, physician offices and agencies to ensure than an accurate and timely referral/authorization is processed and documented in accordance with department guidelines.

Manages and maintains the Electronic Referral Tracking Report for accuracy of information, urgency, and other designated criteria.

Acts as a resource to all internal and external customers, offering guidance and support for referral and authorization related questions and referral/authorization processing problems. Ensures patients receive timely and courteous communications.

Informs referring providers when a requested service authorization request is denied.

Stays current with the insurance authorization requirements by utilizing the resource library of payor benefit-specific information and provider contact information.

Enters referrals and authorizations in to the system per standardized practice protocols and provides feedback to ordering provider and parent/patient in a timely manner.

Documents and provides updates in the patient's medical record, the status of the referral and/or authorization.

Communicates and provides feedback to providers and staff regarding changes, trends, and processes.

**Minimum Qualifications**:High school graduate or GED. At least two years in a medical office or insurance company environment, experience with prior authorizations and referrals required. Medical terminology certificate preferred.

Salary Range: $17.25 - $28.27
Pay Grade: 18
Compensation may vary based upon, but not limited to: overall experience and qualifications, shift, and location.

Location: Saratoga Hospital - Patient Engagement Center

Schedule: Full-Time, Day shift, 80



  • Saratoga Springs, United States Saratoga Hospital Full time

    Summary of Position: The Referral and Prior Authorization Specialist is responsible for obtaining referrals and authorizations to ensure reimbursement for services and testing provided throughout Saratoga Hospital Medical Group (SHMG). Demonstrates excellent communication, strong customer service, critical thinking, and problem solving skills. Completes all...


  • Altamonte Springs, United States AtWork - Orlando North Full time

    Do you want to work for a fortune 500 company and be a part of a new area of growth? We need Pharmacy Prior Authorization Specialists that are looking for a new and exciting opportunity! The Pharmacy Prior Authorization Specialists responsibilities include: Pharmacy Prior Authorization experience Pharmacy claims experience Customer Service experience Patient...


  • Altamonte Springs, United States AtWork - Orlando North Full time

    Do you want to work for a fortune 500 company and be a part of a new area of growth? We need Pharmacy Prior Authorization Specialists that are looking for a new and exciting opportunity! The Pharmacy Prior Authorization Specialists responsibilities include: Pharmacy Prior Authorization experience Pharmacy claims experience Customer Service experience Patient...


  • Saratoga Springs, United States Saratoga Hospital Full time

    Summary of Position:This job description provides information essential to understanding the scope of the position and is not intended to be an exhaustive list of skills, efforts, duties, responsibilities or working conditions associated with the position.The Pre-Service Specialist I (PSS) is responsible for answering scheduling phone calls and scheduling...


  • Coral Springs, United States Safeguard Healthcare Full time

    Job DescriptionJob DescriptionExciting opportunity to join our busy primary care office! We are looking for a meticulous and detail-oriented Referral Coordinator/ Patient Care Coordinator to be responsible for administrative and clerical tasks. The responsibilities include creating a referral request based on appointment type for all physicians and...


  • Coral Springs, United States Safeguard Healthcare Full time

    Job DescriptionJob DescriptionExciting opportunity to join our busy primary care office! We are looking for a meticulous and detail-oriented Referral Coordinator/ Patient Care Coordinator to be responsible for administrative and clerical tasks. The responsibilities include creating a referral request based on appointment type for all physicians and...


  • Saratoga, United States Sutter Health Full time

    **Organization**: SCAH-Sutter Care at Home - Bay **Position Overview**: Provides medical administration support to providers by obtaining referral or prior authorizations for patients to see specialty providers. Completes referrals and/or authorizations accurately and consistently with mínimal supervision. In Managed Care, processes authorization and...

  • Mental Health Nurse

    3 weeks ago


    Dripping Springs, Texas, United States Discovery Mood & Anxiety Program Full time

    Job Description                                               *We welcome new grads* The LVN/LPN works in a dynamic multidisciplinary team providing treatment services according to the Discovery Behavioral Health Clinical Model. LVN/LPN is supervised by an RN/RN Administrator/DON.  Responsibilities Ensures all orders from...


  • Saratoga Springs, United States Albany Med Full time

    Department/Unit: Community Neurosurgery Work Shift: Day (United States of America) Patient Service Associate , Glens Falls, NY Neurosurgery Work Schedule: Monday - Friday We are seeking an Administrative Associate with excellent customer service skills and clerical experience to join our team! The Patient Service Associate provides advanced clerical...

  • Admissions Specialist

    17 hours ago


    Colorado Springs, United States Falcon Heights Health & Rehabilitation Center LLC Full time

    Are you a person who believes in providing great care? Do you believe in having a positive impact on other people's lives? Are you a team-player, quick-thinker, and ready to be a part of an organization that supports your growth?WHAT WE'RE ABOUT We believe care goes beyond a medical chart. With kindness and integrity as our guide, we strive for excellence in...

  • Rn Staff Nurse

    4 days ago


    Saratoga Springs, United States Saratoga Dermatology Full time

    Full time RN needed for a busy Dermatology office. Office hours are Monday - Thursday with occasional Fridays. Job responsibilities include rooming patients, assisting with procedures, patient education, telephone triage, prior authorizations and miscellaneous other duties. Experience in a medical office preferred but not required. Experience with an...


  • Altamonte Springs, United States Elevance Health Full time

    The CarelonRx Sales Support Specialist is responsible for supporting the operations of the sales department. Location: The ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations. How you will make an impact: Completes administrative duties for efficient operations. Notifies physician offices of the outcome of patient...


  • Homosassa Springs, FL 34448, USA, United States The Tampa General Hospital Foundation Inc Full time

    The Care Coordination Specialist Clinics is responsible for assisting in the coordination of patient care with referrals and/or authorizations for services. Works with providers and clinical staff to ensure all orders have been submitted and appropriate documentation is sent to the referral provider. Notifies patient of appointment time and location and/or...


  • Saratoga Springs, United States Saratoga Hospital Full time

    Summary of Position: Performs phlebotomy techniques to obtain blood specimens on patients of all ages.# Interprets and transcribes physician orders onto manual requisitions and into the computer Order Entry System.# Performs all medically necessary activities required.# Assists in lab functions as required for proper specimen accessioning. Assist in training...


  • Saratoga Springs, United States Saratoga Hospital Full time

    **Summary of Position**: Obtains, verifies and records all patient information through the registrations process to ensure proper records for all services received. Provides support for scheduling and ordering of miscellaneous exams when necessary. Assumes responsibility for maintaining confidential patient information and responsible with patient reception,...


  • Saratoga Springs, United States Saratoga Hospital Full time

    **Summary of Position**: Obtains, verifies and records all patient information through the registrations process to ensure proper records for all services received. Provides support for scheduling and ordering of miscellaneous exams when necessary. Assumes responsibility for maintaining confidential patient information and responsible with patient reception,...


  • Saratoga Springs, United States Saratoga Hospital Full time

    Summary of Position: Obtains, verifies and records all patient information through the registrations process to ensure proper records for all services received. Provides support for scheduling and ordering of miscellaneous exams when necessary. Assumes responsibility for maintaining confidential patient information and responsible with patient reception,...

  • Retail Pharmacist

    7 days ago


    Saratoga Springs, United States Saratoga Hospital Full time

    Summary of Position:#Responsible for proper operation of the retail pharmacy.# This responsibility includes assisting the pharmacy manager in oversight of all activities inclusive of, but not limited to, dispensing, inventory control, narcotic drug control, verification and processing of Medicare, Medicaid, and commercial insurance.# Provides ambulatory...

  • Billing Specialist

    1 month ago


    Colorado Springs, United States Adventure Learning Behavioral Interventions Full time

    Job DescriptionJob DescriptionBilling SpecialistAdventure Learning Behavioral Interventions is seeking a skilled Biller to join our company. The Biller plays a crucial role in our operations, ensuring seamless financial processes and facilitating the accessibility of ABA, SLP, OT, and other therapy services for our clients. The Biller at Adventure Learning...


  • Saratoga Springs, United States L3Harris Technologies Full time

    Job Title: Lead,Network Systems EngineerJob Code: 10779Job Location: USA-UT-Salt Lake CityJob Schedule: 9/80, every other Friday offJob Description:The Senior Specialist, Network Systems Engineer will be responsible for the development of advanced communication subsystem hardware/software for multi-domain (space, ground, airborne) applications. The position...