Responsibilities
The Referral Navigator Representative provides administrative support for the referral navigator department. This position is primarily responsible for coordinating with KS clinical staff to assist with the entry of prior authorization requests for utilization review.
This includes interpretation and communication of covered benefits and exclusions, prior handling and appropriately directing prior authorization status requests received from KSC staff and assisting with requesting clinical updates.
Other duties as assigned.
Job Title : Referral Navigator Representative
Location : Pearland Administrative Office
Department : Utilization Management
Job Type : Full Time
Salary Range : $ 35,240 $43,535 (Pay is based on several factors including but not limited to education, work experience, certifications, etc.)
Qualifications
Education
Required : High School diploma or GED from an accredited program
Preferred : Graduate from accredited medical assistant program
Experience
Required : 2 3 years of managed care experience either in a physician office or hospital setting health plan,
ACO, or other managed care setting.
Experience in creating authorization requests or billing Medicare or private insurance companies.
Preferred : Knowledge of CPT & ICD 10 Coding methodologies and billing.
Prior experience with precertification and / or utilization management.
Knowledge of insurance payer specific prior authorizations requirements preferred.
License(s)
Required : N / A
Preferred : Certified medical assistant
Special Skills
Required : Knowledge of medical terminology, coding, COB payment, and prior authorization processes.
Alpha / numeric data entry and basic PC Literacy.
Demonstrate a working knowledge of industry standards processing.
Understanding of Health plan benefits and financial obligation interpretation
Preferred : Strong knowledge of HMO, PPO, and POS plan types a plus including Medicare and commercial
health plans.
Benefit interpretation a plus
Other
Required : Excellent verbal communication and time management skills
Preferred : N / A
Working Environment : Office
About Us
Start your career journey and become a part of a community of renowned Healthcare professionals. Kelsey-Seybold Clinic is Houston’s fastest growing, multispecialty organization with more than 40 premier locations and over 65 specialties.
Our clinics are comprised of more than 600 physicians and as we continue to grow, our focus is providing quality patient care by adding to our team of clinical and non-clinical professionals that work together in a convenient, coordinated, and collaborative manner.
Enjoy the rewards of a successful career while maintaining a work / life balance by joining our team today and changing the way health cares.
Why Kelsey-Seybold Clinic?
- Medical, Vision, and Dental
- Tuition Reimbursement
- Company Matching 401K
- Employee Reward and Recognition Program
- Paid time off for vacation, sick, and holidays
- Employee Assistance Program
- Continuing Medical Education allowance
Referral Navigator Representative
Referral Navigator Representative
The Referral Navigator Representative provides administrative support for the referral navigator department. Job Title: Referral Navigator Representative. Referral Navigator Representative. ...
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