Referral Navigator Representative

A company is looking for a Referral Navigator Representative in Utilization Management.

Key Responsibilities :

Coordinate with clinical staff to assist with prior authorization requests for utilization review

Interpret and communicate covered benefits and exclusions, and manage prior authorization status requests

Perform additional duties as assigned

Required Qualifications :

High School diploma or GED from an accredited program

2+ years of managed care experience in a physician office, hospital setting, health plan, ACO, or other managed care setting

Experience in creating authorization requests or billing Medicare or private insurance companies

Knowledge of medical terminology, coding, COB payment, and prior authorization processes