Top 68 Referral specialist Jobs in Gilbert, Az

Prior Authorization Representative I
Arizona Priority Care —Chandler, AZ
- $20 - $23 an hour
- Full-time
- Hybrid work
- Office
- Administrative experience
- High school diploma or GED
Referral Specialist
TriWest Healthcare Alliance —Phoenix, AZ
- $40,000 - $45,000 a year
- Overtime
- Microsoft Outlook
- Computer literacy
- HIPAA
- AD&D insurance
- Disability insurance
SLPA | Consistent Referrals | Flexible Schedule | $65–$85/Session
Allegiant Therapy —Phoenix, AZ
- $65 - $85 an hour
- Part-time
- Reliable transportation
- Entry level
- Flexible schedule
Quick Apply
1d
Claims Support Specialist
Resilient Health —Phoenix, AZ
- Up to $19 an hour
- Full-time
- Mid-level
- Office
- Administrative experience
- 403(b) matching
- Paid holidays
14d
Authorization Specialist
Canyon Home Care & Hospice LLC —Gilbert, AZ
- Full-time
- Mid-level
- 21 years or older
- Medical terminology
Quick Apply
10d
Customer Service Intake Coordinator
Aspen Infusion —Chandler, AZ
- $21 - $23 an hour
- On call
- Word processing
- Computer literacy
- High school diploma or GED
Referral Specialist
American Vision Partners —Tempe, AZ
- Full-time
- Spanish
- Surgery
- Medical office experience
- Paid holidays
- Health insurance
Patient Intake Specialist (REMOTE)
Aveanna Healthcare —Chandler, AZ
- From $18 an hour
- Full-time
- Remote
- Customer service
- Medical office experience
- HIPAA
- Paid holidays
- Health insurance
Quick Apply
10d
Intake Specialist (In-Office if Local / Remote if Non-Local)
UNITED WOUND HEALING PS —Phoenix, AZ
- $19 - $23 an hour
- Overtime
- Microsoft Outlook
- Pass drug screening
- HIPAA
- AD&D insurance
- Paid holidays
Quick Apply
Authorization Coordinator
Aspen Infusion —Chandler, AZ
- $21 - $24 an hour
- Full-time
- Writing skills
- Basic math
- HIPAA
Transplant Financial Coordinator
Mayo Clinic —Phoenix, AZ
- $29.38 - $39.67 an hour
- Full-time
- Hybrid work
- 5 years
- Mid-level
- High school diploma or GED
- Health savings account
- Health insurance
IBH Referral and Support Specialist MA
Valleywise Health System —Mesa, AZ
- $18.97 - $27.98 an hour
- Full-time
- Spanish
- High school
- English
- Paid holidays
- Health insurance
Transplant Financial Coord-On Site- Arizona
Mayo Clinic —Phoenix, AZ
- $29.38 - $39.67 an hour
- Weekends as needed
- 5 years
- Mid-level
- High school diploma or GED
- Health savings account
- Health insurance
Insurance Liaison (Remote)
Cranial Technologies —Tempe, AZ
- $17 - $18 an hour
- Email
- Remote
- Microsoft Outlook
- Research
- US work authorization
- Paid holidays
- Disability insurance
Quick Apply
Prior Authorization Supervisor
Shields Health Solutions —Gilbert, AZ
- Microsoft Outlook
- Mid-level
- High school diploma or GED
Quick Apply
Prior Authorization Representative Neurology
Banner Health —Mesa, AZ
- Full-time
- Vital signs
- Word processing
- High school diploma or GED
2h
Dental Referral Marketer - Phoenix
Wisdom Teeth Guys —Phoenix, AZ
- $60,000 - $72,000 a year
- Full-time
- Dental office
- Mid-level
- Marketing
Quick Apply
Contact Center Trainer - Scheduling and Referrals - Hybrid
Neighborhood Outreach Access to Health (NOAH) —Phoenix, AZ
- $51,688 - $65,457 a year
- Weekends as needed
- Background check
- Classroom
- Spanish
- Health insurance
- Dental insurance
Quick Apply
Prior Authorization Specialist
Foothills Neurology P C —Phoenix, AZ
- $20 - $25 an hour
- Medical office experience
- HIPAA
- Mid-level
Quick Apply
Insurance Verification Specialist
Gold Canyon Dentistry —Gold Canyon, AZ
- $24 - $26 an hour
- Full-time
- Dental office
- Research
- Mid-level
- Dental insurance
- 401(k)
Quick Apply
4d

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Prior Authorization Representative I

Arizona Priority Care -
Chandler, AZ

Apply Now

Job Details

Full-time
$20 - $23 an hour

Qualifications

Administrative experience
High school diploma or GED
ICD-10
HCPCS
Desktop applications
Medical terminology

Full Job Description

Arizona Priority Care (AZPC) is an Integrated Provider Network focused on providing whole-person care to Senior and Medicaid populations, through advanced value-based models. Our provider network is comprised of more than 6,000 health care providers, including primary and specialty care physicians, hospitals and ancillary providers. We have operated in the Arizona market for more than 14 years, based in Chandler, Arizona, and are an affiliate of Heritage Provider Network. As a leading value-based provider organization, we are committed to improving the quality of care, providing excellent member and provider experiences all while reducing cost.

The Prior Authorization Representative I is responsible for processing incoming requests including verifying eligibility and benefits and the data entry component of the prior authorization request. The PA Rep I works closely with all UM Staff, Prior Auth Supervisor, and management to maintain turnaround time requirements of the contracted health plan, regulatory bodies, and internal goals. Routinely interacts with physicians, their office staff and internal customers.

POSITION DUTIES & RESPONSIBILITIES

Assist in managing the incoming prior authorization request by following work direction given by the Prior Authorization management to ensure Routine/Standard and Urgent/Expedited prior authorizations are processed in the appropriate amount of time and in compliance with regulatory and health plan requirements.
Complete a minimum data entry or adjudication of 40 authorizations per day.
Assist in reviewing and distributing incoming prior authorization requests including identifying Urgent/Expedited vs Routine/Standard, verifying member eligibility, delegated vs non-delegated services, retro vs. future date of services, accuracy checking documentation, and routing to appropriate folder.
Perform data entry of prior authorization requests with a minimum of 97% accuracy including primary insurance or hospice verification, determine if requested services require prior authorization, and confirm request is not duplicative.
Perform adjudication of authorization requests with a minimum of 97% accuracy including quality checking data entry, reviewing historical utilization management history to include program enrollment and verifying if rendering provider and facility is contracted, any tasks related to processing a prior authorization request (provider loads, out of network (OON) credentialing, accreditation verification, etc.), providing redirect information for OON requests, and routing to the appropriate queue or vendor.
Contact the provider’s office for additional information per CMS and AZPC policies and guidelines.
Make expedited determination notifications to member and provider.
Provide exceptional, courteous, and professional phone customer service.
Educate practitioners as needed with the Authorization/Referral process.
Perform as necessary accommodate to departmental change, workload and emergencies.
Maintain current knowledge of CMS and NCQA standards, and AZPC UM Policies and procedures.
Protect privacy for patients, providers, and employees; ensure all personal health information is kept confidential.
Demonstrate caring, empathy, patience, respect and compassion for all team members.
Demonstrate honesty and integrity in everyday activities.
Perform other duties as directed by management.

EDUCATION, TRAINING AND EXPERIENCE

Highschool Diploma or GED – Required.
Minimum of 1-year administrative healthcare related experience – Required.
Proficient knowledge of medical terminology, CPT-4, HCPCS, and ICD-10 – Required.
Working knowledge of computer applications, such as Microsoft Office applications.
Excellent oral and written communication skills.
Demonstrated ability to be detail-oriented and multi-task effectively.
Able to interact effectively with all levels of staff.

Pay Range: $20.00 – $23.00/hour

*This role requires 60 days FT in office presence, hybrid options will be available after the 60-day period.*

Apply Now

Refine Your Search

referral specialist jobs in gilbert, az

Prior Authorization Representative I

Referral Specialist

SLPA | Consistent Referrals | Flexible Schedule | $65–$85/Session

Claims Support Specialist

Authorization Specialist

Customer Service Intake Coordinator

Referral Specialist

Patient Intake Specialist (REMOTE)

Intake Specialist (In-Office if Local / Remote if Non-Local)

Authorization Coordinator

Transplant Financial Coordinator

IBH Referral and Support Specialist MA

Transplant Financial Coord-On Site- Arizona

Insurance Liaison (Remote)

Prior Authorization Supervisor

Prior Authorization Representative Neurology

Dental Referral Marketer - Phoenix

Contact Center Trainer - Scheduling and Referrals - Hybrid

Prior Authorization Specialist

Insurance Verification Specialist

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