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Referral Specialist

WFM, Remote
Role: Referral Specialist
Contract: 11+ Months
Location: Remote

Payrate $15/hr on w2

Job Responsibilities

The referral specialist is responsible for reviewing and entering accurate authorizations within the established system while maintaining high-quality standards and meeting clients’ expectations. The referral specialist must follow all market-specific guidelines about authorization entry and meet established timelines specified by the market.

Essential Duties and Responsibilities
 
  • Review authorization files and/or faxes for accuracy and completeness of data
  • Confirm member’s eligibility
  • Enter all member authorizations for approved, denied, and partially approved inpatient/outpatient services into the computer system following payor policies and procedures
  • Utilizes a high degree of accuracy in obtaining and verifying that all registration data, demographic and insurance information is correct and up to date
  • Prioritizes authorizations for routine, urgent, and emergent requests within the appropriate timeframe.
  • Appropriately forwards all referral requests to the next level of review if necessary
  • Follow specific client guidelines/protocols for case building
  • Submits appropriate medical records according to established criteria for requested service(s)
  • Ensure established processing timeframes are met for each business unit
  • Create and maintain reference materials and workflows for data processing
  • Documents and communicates areas of concern to the supervisor
  • Track and maintain daily reporting log
  • Performs duties honestly and ethically.
  • Perform other duties as assigned




Regards,

Rahul Yadav
(408) 560-3956
rahul@reqroute.com
http://reqroute.catsone.com/careers/index.php (Click to see MOST Current Openings)

 
Companies across U.S. have engaged ReqRoute, Inc to deliver skilled, dedicated IT professionals. Recruiting is our passion and we support Fortune 1000 companies with their hiring needs. We always seek to deliver competitive and sought-after career opportunities to our potential consultants and employees. We invite you to review the position requirements and apply today if your skills match our needs.  
 
ReqRoute, Inc is an Equal Opportunity Employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, disability, military status, national origin or any other characteristic protected under federal, state, or applicable local law. (www.reqroute.com)

 

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