Referral & Prior Authorization Specialist

Arcturus Healthcare is seeking a detail-oriented and knowledgeable Referral & Prior Authorization Specialist to join our team. This position is responsible for managing the referral and prior authorization process from start to finish, ensuring patients receive timely access to medically necessary services, testing, and appointments.

The ideal candidate will have experience working in a medical office environment, a strong understanding of medical terminology and chart documentation, familiarity with medications, and excellent communication and organizational skills. Experience with chronic care management calls and patient outreach is highly valued.

Responsibilities

• Manage and process patient referrals and prior authorizations in a medical office setting.
• Complete all aspects of the prior authorization process, including gathering required clinical documentation and submitting authorization requests to insurance companies.
• Review patient charts and medical documentation to obtain the information necessary to support referrals, testing, procedures, and services.
• Communicate with patients, physicians, clinical staff, insurance companies, and outside providers to coordinate referrals and authorizations.
• Contact patients when additional information, documentation, or follow-up is needed.
• Track referrals and prior authorizations to ensure timely completion and appropriate follow-up.
• Obtain and verify required insurance authorizations, referrals, and supporting documentation.
• Document referral and authorization activity accurately in the electronic medical record (EMR).
• Perform patient outreach and chronic care management calls as assigned, providing appropriate follow-up and assisting patients with coordination of care.
• Utilize knowledge of medical terminology, medications, diagnoses, procedures, and clinical documentation when reviewing charts and processing referrals and authorizations.
• Maintain accurate and timely records of all referral, authorization, and patient follow-up activities.
• Provide professional and compassionate customer service to patients and address questions or concerns regarding referrals, authorizations, testing, and appointments.
• Work closely with providers and clinical staff to obtain necessary information and resolve referral or authorization issues.
• Maintain patient confidentiality and comply with HIPAA and applicable healthcare regulations.
• Perform other duties as assigned to support the needs of the medical practice.

Qualifications & Experience

• Previous experience working in a medical office or healthcare setting preferred.
• Experience with referrals, prior authorizations, insurance verification, or care coordination preferred.
• Strong knowledge of medical terminology and chart documentation.
• Familiarity with medications, diagnoses, medical procedures, and common healthcare services.
• Experience with chronic care management calls, patient outreach, or care coordination is a plus.
• Familiarity with health insurance plans, referral requirements, and prior authorization processes.
• Strong attention to detail and ability to accurately review and interpret medical documentation.
• Excellent written and verbal communication skills.
• Strong organizational and time-management skills with the ability to prioritize multiple tasks and meet deadlines.
• Professional and compassionate approach to patient communication.
• Ability to work independently while also functioning effectively as part of a team.
• Proficient computer skills and the ability to learn and navigate electronic medical records and other healthcare systems.
• Ability to maintain confidentiality and handle sensitive patient information appropriately.

Join Our Team

If you are looking for an opportunity to contribute to the success of our medical offices while helping patients navigate their healthcare needs, we invite you to apply for the Referral & Prior Authorization Specialist position. Join our team and become part of a dynamic, professional, and supportive healthcare environment where your knowledge and skills make a difference in patient care. Please submit your resume for consideration. We look forward to reviewing your application!