In this Referral and Prior Authorization Specialist role, you will serve as the crucial link connecting patients to the specialized care they need. Your day will center around managing an inbound phone queue, researching authorization requests, verifying patient eligibility and benefits, and confirming provider network status. We are seeking an adaptable professional with at least four years of healthcare experience such as front/back office, medical billing, or claims processing who possesses medical terminology and knowledge of CPT and ICD-9/10 coding. If you are an organized problem-solver with outstanding communication skills and a passion for high-touch service, you will feel right at home. Key Responsibilities: Review and initiate prior authorization and referral requests for outside medical care. Research authorization requests and manage an inbound phone queue with top-tier customer service. Verify patient insurance eligibility, benefits, coverage, and network provider status. Ensure all authorization requests are handled accurately within required compliance timeframes. Document case outcomes and coordinate care across medical software applications. Qualifications & Requirements: 4+ years of healthcare experience (medical office, claims processing, billing, or authorizations). High School Diploma or GED required; associate degree or some college preferred. Working knowledge of medical terminology, CPT, and ICD-9/10 coding. Proficiency with standard office software suites; Epic / Health Connect experience is a plus. Proven customer service, time management, and multitasking skills in a dynamic, fast-paced environment.
salary: $24.99 - $25 per hour shift: First work hours: 8:30 AM - 5 PM education: High School
Responsibilities
Review and initiate prior authorization and referral requests for outside medical care. Research authorization requests and manage an inbound phone queue with top-tier customer service. Verify patient insurance eligibility, benefits, coverage, and network provider status. Ensure all authorization requests are handled accurately within required compliance timeframes. Document case outcomes and coordinate care across medical software applications.
Skills
- healthcare experience
- medical terminology
- standard office software suite
Qualifications
- Years of experience: 4 years
- Experience level: Experienced
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Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.
At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact HRsupport@randstadusa.com.
Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).
This posting is open for thirty (30) days.