Top 50 Authorizations specialist Jobs in Rhode Island

Referral & Authorization Specialist
Care New England Health System —Warwick, RI
- Full-time
- Bilingual
- Customer service
- HIPAA
1d
Authorizations Specialist
Rhode Island Medical Imaging —Warwick, RI
- Monday to Friday
- Hybrid work
- Bilingual
- Computer literacy
- HIPAA
- Profit sharing
- Loan repayment program
Quick Apply
Insurance Benefit Specialist
Highbar Physical Therapy —Providence, RI
- From $20 an hour
- Full-time
- High school diploma or GED
- Entry level
- Wellness program
- Paid holidays
Quick Apply
Sr Benefits Specialist
Citizens Financial Group —Johnston, RI
- $69,300 - $115,000 a year
- Overtime
- Background check
- Oracle
- HIPAA
- Health insurance
- Dental insurance
Referral Specialist
Brown University Health —East Providence, RI
- $19.03 - $31.39 an hour
- 8 hour shift
- Mid-level
- High school diploma or GED
- 2 years
7d
Authorization Specialist/Biller
Care New England Health System —Warwick, RI
- Full-time
- English
- Research
- Mid-level
Insurance Authorization Specialist
Highbar Physical Therapy —Providence, RI
- From $20 an hour
- Full-time
- High school diploma or GED
- Front desk
- Outpatient
- Wellness program
- Paid holidays
Quick Apply
Medicaid Rebate Analyst Services Specialist
Conduent State Healthcare, LLC —Rhode Island
- $30 an hour
- Email
- Remote
- Customer service
- Research
- Mid-level
- Paid training
- Paid holidays
Automotive Customer Support Specialist
Concentrix —Rhode Island
- $23 an hour
- Urgently hiring
- Hybrid work
- 18 years or older
- Computer literacy
- Writing skills
- Paid holidays
- Health insurance
13d
BH Link Care Coordination Specialist (Full Time)
Community Care Alliance —East Providence, RI
- Full-time
- Bilingual
- Adults
- Mid-level
- 403(b) matching
- Mileage reimbursement
Billing Specialist
Care New England Health System —Warwick, RI
- Full-time
- Word processing
- English
- Mid-level
Legal Administrative Specialist
KMRG, LLC —Providence, RI
- $39.72 - $44.81 an hour
- Full-time
- Mid-level
- Databases
- High school diploma or GED
- Travel reimbursement
7h
Witness Support Specialist
KMRG, LLC —Providence, RI
- $39.72 - $44.81 an hour
- Full-time
- Mid-level
- Databases
- High school diploma or GED
- Travel reimbursement
7h
Assistive Technology Specialist
Rhode Island College —Providence, RI
- $70,000 a year
- Weekends as needed
- Spanish
- Microsoft Excel
- Customer service
- Wellness program
- Disability insurance
Senior Payroll Specialist
Care New England Health System —Providence, RI
- Full-time
- 5 years
- English
- High school diploma or GED
Sr. Litigation Specialist -Remote
CSAA Insurance Services, Inc. —Pawtucket, RI
- $89,865 - $119,800 a year
- Extended hours
- Remote
- Bilingual
- Bachelor of Science
- High school diploma or GED
- 401(k) matching
Physical Therapy Support Specialist
Concentra —Providence, RI
- $18.18 - $23.63 an hour
- Full-time
- Microsoft Excel
- Microsoft Outlook
- HIPAA
- Commuter assistance
- Disability insurance
Helicopter Communication Specialist
HELISERVICE USA LLC —North Kingstown, RI
- $25 - $28 an hour
- Part-time
- Hybrid work
- Customer service
- Pass drug screening
- Mid-level
- Disability insurance
- Dental insurance
7d
Medical Professional, LPN
Octapharma —Providence, RI
- $27.28 - $45.47 an hour
- Weekends as needed
- CPR Certification
- RN License
- Computer literacy
- Wellness program
- Health savings account
8d
VFD Technical Support Specialist
ABB Inc. —Providence, RI
- $52,500 - $84,000 a year
- Full-time
- Computer literacy
- English
- Mid-level
- Health savings account
- AD&D insurance
Quick Apply
1d

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Referral & Authorization Specialist

Care New England Health System -
Warwick, RI

Apply Now

Job Details

Full-time
1 day ago

Qualifications

Customer communication
HIPAA compliance
Electronic health records (EHR) management
Customer service
HIPAA
High school diploma or GED
Patient interaction
Productivity software
Medical terminology
Workday

Full Job Description

Job Summary:

The Referral and Authorization Specialist plays a vital and strategic role in supporting the financial health of the organization by overseeing the referral and authorizations processes for specialty visits and outpatient testing. This position is essential in centralizing and streamlining the authorization workflow, which is integral to the success of the organization’s operations, patient experience, and financial performance. Obtaining timely and accurate authorization information, prior to performing services, reduces claim denials, ensures payer compliance, and establishes better organizational financial outcomes. This position is crucial to the organization's financial success and the delivery of a positive provider and patient experience, as their timely and accurate processing of referrals and authorizations ensures that patients receive the necessary care without delays, while also optimizing reimbursement.

Duties & Responsibilities:

Request and obtain insurance referral and prior authorizations via the insurance carrier and/or third-party authorization companies and then track the status within CNE’s EHR.
Evaluate payer policies to understand authorization and notice of admission policies.
Communicate the request/status of the insurance referral and/or prior authorization with internal referring provider offices/departments via the EHR.
Utilize CNE’s EHR to document all work related to obtaining and/or verifying insurance referral and prior authorizations.
Work with both internal and external referring provider offices/departments to obtain the necessary information to obtain and/or verify the approval of the insurance referral or prior authorization.
Verify the accuracy of the patient’s insurance information to obtain the insurance referral or prior authorization.
Communicate via the EHR any issues related to processing the referral (i.e., PCP not updated with the payer, provider documentation not complete) and/or the accuracy of the patient’s insurance information to the referring department.
Communicate any issues related to obtaining and/or verifying the approval of the insurance referral and/or prior authorization to management.
Manage the start of the external referral process for all CNEMG PCPs, to include submitting referrals, obtaining an approved insurance authorization, and sending all relevant clinical documentation to the external provider.
Explain the Notice of Non-Covered Service Waiver and Notice of Non-Approved Prior Authorization waiver to patients.
Work and monitor EHR WQ’s and in Basket pools through the workday.
Performs other duties as assigned.

Requirements:

Education & Experience:

High School or GED is required. Associate degree or Certified/Registered Medical Assistance preferred. 5-7 years of experience working in healthcare. 3 years of experience processing insurance referral and/or prior authorizations. Bilingual preferred.

Knowledge, Skills, & Abilities:

Ability to communicate with people of various diverse backgrounds in a sensitive and compassionate way.
Knowledge of federal regulations related to the No Surprises Act and healthcare billing compliance.
Must have excellent presentation, communication, organizational and customer service skills.
Strong understanding of payer requirements, authorization processes, insurance and medical terminology.
Possesses specialized level of knowledge and thorough understanding of the systems/applications and subjects listed below:
- Microsoft 365 (formerly Microsoft Office)
- EHRs, specifically EPIC, and
- HIPAA
Always puts patients’ needs first and ensures that quality and safety requirements are met.
Possesses strong listening, communication (written and verbal) and people skills to positively interact with patients, and staff at all levels of the organization.
Strong critical thinking skills with the ability to troubleshoot and resolve issues

About Us:

Care New England Health System (CNE) and its member institutions, Butler Hospital, Women & Infants Hospital, Kent Hospital, VNA of Care New England, Integra, The Providence Center, and Care New England Medical Group, is a trusted, integrated health care organization that fuels the latest advances in medical research, attracts the nation’s top specialty-trained doctors, hones renowned services and innovative programs, and engages in the important discussions people need to have about their health and end-of-life wishes. Care New England is helping to transform the future of health care, providing a leading voice in the ongoing effort to ensure the health of the individuals and communities we serve.

Americans with Disability Act Statement: External and internal applicants, as well as position incumbents who become disabled must be able to perform the essential job-specific functions either unaided or with the assistance of a reasonable accommodation, to be determined by the organization on a case-by-case basis.

EEOC Statement: Care New England is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status

Ethics Statement: Employee conducts himself/herself consistent with the ethical standards of the organization including, but not limited to hospital policy, mission, vision, and values.

Apply Now

Refine Your Search

authorizations specialist jobs in rhode island

Referral & Authorization Specialist

Authorizations Specialist

Insurance Benefit Specialist

Sr Benefits Specialist

Referral Specialist

Authorization Specialist/Biller

Insurance Authorization Specialist

Medicaid Rebate Analyst Services Specialist

Automotive Customer Support Specialist

BH Link Care Coordination Specialist (Full Time)

Billing Specialist

Legal Administrative Specialist

Witness Support Specialist

Assistive Technology Specialist

Senior Payroll Specialist

Sr. Litigation Specialist -Remote

Physical Therapy Support Specialist

Helicopter Communication Specialist

Medical Professional, LPN

VFD Technical Support Specialist

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