Physician Auth/Referral Specialist

1 week ago


Wilmington, United States Nemours Full time
Remote Position. Candidates must live in Delaware, New Jersey or Pennsylvania.

8:30am-5pm

The Specialist is responsible for obtaining and processing Elective, Urgent, and Emergent referrals and authorizations for physician based services and some office based services, including but not limited to cardiology, audiology test, laboratory testing.

The Specialist is also responsible for obtaining genetic testing approval and medication authorizations and other assigned outpatient services. The Specialist will work with partner hospitals for claim submission and registration accuracy. They will also ensure that patient responsibility estimates are created and communicated timely. Elective referrals and authorizations are obtained prior to the service date according to the department standard. Urgent/Emergent referrals and authorizations are to be initiated at the time of the service and must be completed according to insurance company guidelines. Referrals and authorizations are obtained prior to the date of service as per department standards. During the authorization/referral process the specialist will provide the insurance company and or pcp office with all required patient information by fax, phone, or online submission. They will partner with the Primary Care Provider to obtain all approvals as needed per insurance company requirements. This role is required to use all utilize all available resources to verify eligibility, benefits and patient out of pocket responsibilities. Estimates are prepared during the authorization process for in office testing and procedures.

The Specialist is also responsible for researching and notifying the servicing departments of co-payment responsibilities. It is the very important that the Specialist understand and interpret benefits correctly in order to communicate and estimate out of pocket responsibility according to the patients insurance benefit. Should a service date approach without prior authorization and or referral the specialist will follow the Administrative Approval process to ensure that patient responsibility is accounted for.

This position collaborates with: Hospital Authorization department, non Nemours physician offices, managed care department and Nemours Physicians, and Departmental Administrative Staff to ensure that accurate information is collected and distributed effectively and efficiently.

Qualifications:
  • High School Diploma required
  • Referral/authorization experience required
  • CRCR preferred
Nemours Children's Health offers a comprehensive and competitive benefit package which includes:
  • Medical/Dental/Vision Insurance
  • Tuition Reimbursement/Continuing Education Support
  • 403(b) Retirement Plan
  • Paid Time Off (PTO), VTO (Volunteer Time Off) and 6 paid holidays
  • Professional/Clinical growth opportunities
  • Work Life Benefits

  • Neurology Physician

    3 weeks ago


    Wilmington, United States Summit Recruiting Group Full time

    Neurology Openings: Wilmington, NC Coastal NCSeeking candidates for General, Movement Disorders, and/or HeadacheH1b Eligible Position Details: - Full-time, permanent- Employed- Outpatient- The new movement specialist will join 2 existing movement disorder providers and will have the option to perform DBS programming. - The practice in Wilmington is home to...


  • Wilmington, United States Seaboard Physician Search Full time

    p>We are seeking a highly motivated, quality focused, BC/BE Gastroenterologist, who enjoys a busy inpatient/outpatient practice. HIGHLIGHTSEstablished growing practice of four providersOnsite Endoscopy Unit (directly beside clinic space and 1/4th a mile from local hospital)Efficient established nursing teamOnsite diagnostics including MRI, CT, Lab and...

  • Physician Assistant

    1 month ago


    Wilmington, North Carolina, United States Allegiance Health Full time

    Job Title: Physician Assistant - Veteran Care SpecialistWe are seeking a compassionate and skilled Physician Assistant to join our team in Wilmington, NC. As a Veteran Care Specialist, you will be responsible for performing military disability exams and providing medical opinions to support our veteran patients.Responsibilities:Conduct focused exams for...


  • Wilmington, North Carolina, United States All Medical Personnel Full time

    Job Title: RN - PCU/Stepdown SpecialistJob Summary: We are seeking a skilled RN - PCU/Stepdown Specialist to join our team. The ideal candidate will have 2-3 years of recent telemetry experience and hold certifications in BLS, ACLS, and NIHSS.Responsibilities:* Assist physicians with patient management* Identify irregular telemetry readings and notify the...


  • Wilmington, Delaware, United States ALOIS Healthcare Full time

    Job Title: Travel Nurse RN Endoscopy SpecialistJob Description:We are seeking a skilled Travel Nurse RN Endoscopy Specialist to join our team at ALOIS Healthcare. As a Gastrointestinal Lab nurse, you will specialize in GI tract diseases and disorders, assisting physicians with various procedures and treatments, and providing patient education.Key...

  • Academic Medicine

    2 weeks ago


    Wilmington, United States Planet Healthcare Full time

    Planet Healthcare is seeking a full-time Geriatric Medicine physician to join its Program of All-Inclusive Care for the Elderly (PACE) organization located in New Castle County, Delaware.The physician provides primary medical care to participantsCarries out medical procedures as indicatedParticipate as a member of the interdisciplinary teamRefer participants...

  • Urology Specialist

    4 weeks ago


    Wilmington, Delaware, United States Delta Physician Placement Full time

    Urology Opportunity OverviewHospital Employed Urology Opportunity with Established Group of Urologists. Each Urologist will have their own PA, consulting less than 4 hours a day. Clinic: 15-20 patients per day. OR: 5-7 / 1 OR day a week to start, with call max 7 days/month. No admitting required, and PAs will do the rounding. Mon-Friday: 9:30 - 4PM, with...

  • Internal Medicine

    3 weeks ago


    Wilmington, United States Planet Healthcare Full time

    Planet Healthcare is seeking a full-time Geriatric Medicine physician to join its Program of All-Inclusive Care for the Elderly (PACE) organization located in New Castle County, Delaware.The physician provides primary medical care to participantsCarries out medical procedures as indicatedParticipate as a member of the interdisciplinary teamRefer participants...

  • MRI Technologist

    4 weeks ago


    Wilmington, Delaware, United States PSG Global Solutions Careers Full time

    Diagnostic Imaging SpecialistWe are seeking a skilled MRI Technologist to join our team at PSG Global Solutions Careers. As a Diagnostic Imaging Specialist, you will be responsible for performing MRI diagnostic imaging procedures on patients of all ages to assist in the diagnosis of patient illness.Responsibilities: Perform MRI diagnostic imaging procedures...


  • Wilmington, United States Liberty Health Full time

    Job DescriptionJob DescriptionLiberty CaresWith CompassionAt Liberty Home Care we know that following an illness, trauma or surgery, the ability to recover at home can greatly improve patient outcomes. Our healthcare professionals are dedicated to offering recovery with independence to our patients.We are currently seeking an experienced:TRANSITIONAL CARE...


  • Wilmington, United States Source Medical, LLC. Full time

    Opening for Maternal-Fetal Medicine Physician in Wilmington, NC Seeking a MFM Specialist Provider to join one of the largest medical groups in the nation - Full Time, Permanent Position - BC/BE - Work Schedule: 8:00am-5:00pm - Referral-based practice that offers pre-natal diagnosis, genetic counseling, first trimester screening, amniocentesis, antepartum...


  • Wilmington, Delaware, United States Integrity Healthcare Full time

    Join Our Team at Integrity HealthcareJob SummaryWe are seeking a skilled Physician / Anesthesiology Specialist to join our team at Integrity Healthcare. As a Pain Management and Anesthesiology Physician, you will be responsible for providing high-quality patient care and contributing to the growth and success of our organization.About the RoleThis is a...


  • Wilmington, Delaware, United States Novant Health Medical Group Full time

    Job Title: Gastroenterology SpecialistJob Summary:Novant Health Medical Group is seeking a skilled Gastroenterology Specialist to join their established team in Wilmington, NC.The ideal candidate is a board-certified/board-eligible Gastroenterologist with a strong background in providing full-spectrum GI care.Experience with ERCP, EUS, and advanced training...


  • Wilmington, United States Source Medical, LLC. Full time

    Opening for Maternal-Fetal Medicine Physician in Wilmington, NC Seeking a MFM Specialist Provider to join one of the largest medical groups in the nation - Full Time, Permanent Position - BC/BE - Work Schedule: 8:00am-5:00pm - Referral-based practice that offers pre-natal diagnosis, genetic counseling, first trimester screening, amniocentesis, antepartum...

  • Pediatrics Physician

    2 weeks ago


    Wilmington, United States Summit Recruiting Group Full time

    Pediatric Surgeon Opening - Wilmington, NC Position Details - Full-time, permanent- Employed- Recruiting a 3rd Pediatric Surgeon to be part of a team providing surgical consultation and care to children. - The facility includes a 45 bed level III NICU, 17 bed pediatric Unit, and 6 bed Level II PICU- This collaborative team of Pediatric Hospitalists,...


  • Wilmington, Delaware, United States Novant Health Full time

    Diagnostic Imaging SpecialistAt Novant Health, we are seeking a skilled Diagnostic Imaging Specialist to join our team. As a Diagnostic Imaging Specialist, you will assist physicians in the performance of diagnostic and therapeutic procedures by preparing patients and operating ultrasound equipment to obtain diagnostic scans.Key Responsibilities:Prepare...

  • Physician - Craven CI

    4 weeks ago


    Wilmington, Delaware, United States State of North Carolina Full time

    Job Summary: We are seeking a skilled Physician to join our team at the Craven Correctional Institution. The successful candidate will provide primary care services to offenders, including acute and chronic medical care, preventive health services, and health education. Responsibilities:Provides medical care to all offender patients assigned to this...


  • Wilmington, Delaware, United States Tandym Group Full time

    A skilled Dermatology Specialist is needed to join the Tandym Group team in Wilmington, Delaware. The ideal candidate will have a strong background in healthcare and be licensed as a Nurse Practitioner (NP) and/or Physician Assistant (PA).Key Responsibilities:The Dermatology Specialist will:Conduct thorough skin exams to identify potential skin conditions,...

  • Academic Medicine

    7 days ago


    Wilmington, United States RecruitWell Full time

    strong>Wilmington, Delaware, Geriatric Medicine JobClinical Role:The physician provides primary medical care to participants, including assessment, development of a plan of care in collaboration with the interdisciplinary team, provision of direct participant medical care, and evaluation of effectiveness of the plan of Functions in a collegial relationship...


  • Wilmington, Delaware, United States Novant Health Full time

    OverviewWe are seeking a skilled Maternal-Fetal Medicine Specialist to join our team at Novant Health Maternal Fetal Medicine - Shipyard. As a referral-based practice, we offer a range of services including pre-natal diagnosis, genetic counseling, first trimester screening, amniocentesis, ante-partum testing, consultation, and management for high-risk...