Authorization & Referral Specialist
Position Summary
Orthopedic Center of Palm Beach County is seeking a detail-oriented Authorization & Referral Specialist to join our growing team. This position is responsible for obtaining insurance authorizations and managing patient referrals to ensure timely access to orthopedic care. The ideal candidate is knowledgeable in insurance guidelines, prior authorization requirements, referral management, and thrives in a fast-paced, multi-provider practice.
Essential Duties & Responsibilities
- Obtain prior authorizations for:
- Hyaluronic Acid (HA) injections
- Corticosteroid and other therapeutic injections
- Additional orthopedic procedures requiring insurance authorization
- Process and track primary care physician (PCP) referrals and HMO referrals.
- Verify insurance eligibility and benefits as needed.
- Submit authorization requests through insurance portals and by phone.
- Monitor pending authorizations and referrals to ensure timely approvals.
- Coordinate peer-to-peer reviews and obtain additional clinical documentation from providers when requested by insurance carriers.
- Appeal denied authorizations and submit reconsideration requests when appropriate.
- Communicate authorization and referral status with providers, medical assistants, front office staff, schedulers, and patients.
- Maintain accurate documentation within AthenaOne and other applicable systems.
- Stay current on payer policies, Medicare, commercial insurance, workers' compensation, and prior authorization requirements.
- Collaborate with physicians and clinical staff to ensure documentation supports medical necessity.
- Perform other related duties as assigned.
Qualifications
- High school diploma or equivalent required; medical office certification or associate degree preferred.
- Minimum of two years of experience in medical prior authorizations, referrals, or insurance verification.
- Orthopedic or specialty practice experience strongly preferred.
- Knowledge of commercial insurance, Medicare, Medicare Advantage, workers' compensation, and HMO referral requirements.
- Experience using AthenaOne or a similar electronic medical record (EMR) system preferred.
- Strong organizational, problem-solving, and time management skills.
- Excellent verbal and written communication skills.
- Ability to manage multiple priorities while maintaining accuracy and meeting deadlines.
Skills & Competencies
- Attention to detail
- Critical thinking and problem-solving
- Strong customer service skills
- Ability to work independently and collaboratively
- Knowledge of medical terminology and orthopedic procedures
- Proficiency with EMR systems and Microsoft Office
Benefits
- Competitive pay based on experience
- Medical, dental, and vision insurance
- Paid time off and paid holidays
- 401(k) with employer-sponsored benefits
- Opportunities for professional development and advancement
Join Orthopedic Center of Palm Beach County and become part of a team dedicated to providing exceptional patient care through efficient insurance coordination and seamless access to orthopedic services.
Pay: $18.00 - $21.00 per hour
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Disability insurance
- Health insurance
- Health savings account
- Life insurance
- Paid time off
- Vision insurance
Work Location: In person
