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Outpatient Referral Specialist

2 months ago

Rancho Cucamonga, California, United States HealthCare Support Full time
Job Overview

Position: Outpatient Referral Specialist - Hybrid Role

HealthCare Support is currently seeking a dedicated Outpatient Referral Specialist to join our team within a prominent not-for-profit health plan.

Key Responsibilities:
  • Assist in the efficient processing of authorization requests under the guidance of the Utilization Management (UM) team.
  • Verify patient eligibility and gather necessary information as required by Medical Management.
  • Maintain organization and multitasking capabilities while applying knowledge of ICD-9/10, CPT coding, and medical terminology.
  • Ensure timely responses to provider inquiries while delivering exceptional customer service.
  • Collaborate with various departments to meet member needs and foster strong professional relationships.
Essential Duties:
  • Monitor the Right Fax Server to ensure prompt processing of referrals.
  • Review referral forms for completeness and gather any missing demographic information.
  • Meet accuracy standards for authorizations at the UM Coordinator level.
  • Represent the organization professionally while handling calls for the Utilization Management Department.
  • Communicate effectively with providers regarding authorizations and related matters.
  • Support management and nursing staff as needed.
Qualifications:
  • High school diploma or GED required; Associate's or Bachelor's degree preferred.
  • Minimum of 3 years of experience in healthcare data entry.
  • At least 2 years of experience with authorizations and referrals in a managed care organization or medical office.
  • Familiarity with ICD and CPT codes, along with medical terminology.
  • Proficient typing skills, with a minimum typing speed of 40 WPM.
  • Strong computer skills, particularly in Microsoft Office.
  • Organizational skills and the ability to multitask effectively.
Additional Information:
  • This is a contract position.
Benefits:
  • Health Insurance enrollment upon hire.
  • Dental and Life Insurance options.
  • Employee Assistance Program (EAP).
  • Access to investment accounts.
  • Career development resources available through our Ingenovis ACT Program.

HealthCare Support is an equal opportunity employer and welcomes applications from all qualified individuals without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable law.