Top 40 Denial prevention specialist Jobs in Remote

Referral Authorization Specialist
Samaritan —Washington, DC
- $21.24 - $28.84 an hour
- Full-time
- Remote
- Heavy lifting
- HIPAA
- Mid-level
Quick Apply
Lead Clinical Documentation Specialist
Ascension —Remote
- $96,208.99 - $134,109.89 a year
- Full-time
- Remote
- Management
- High school diploma or GED
- Mentoring
- Disability insurance
- Health insurance
Cash Posting Specialist - Healthcare (Full-time)
TwelveStone Health Partners Inc —Murfreesboro, TN
- Full-time
- Remote
- Basic math
- Research
- High school diploma or GED
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Workers Compensation Authorization & Verification Specialist
Ivy Rehab Network —White Plains, NY
- $20 - $23 an hour
- Full-time
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- Mid-level
- Analysis skills
- 2 years
- Paid parental leave
- Paid holidays
Quick Apply
Senior Director, Revenue Cycle Management - REMOTE
Abound Health —Remote
- $115,000 - $150,000 a year
- Full-time
- Remote
- 6 years
- Analysis skills
- Senior level
- Health insurance
- Dental insurance
Quick Apply
4d
Professional Billing Specialist
Singing River Health System —Tallahassee, FL
- Weekends as needed
- Remote
- Microsoft Outlook
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- 5 years
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Account Reimbursement Specialist – Healthcare
TwelveStone Health Partners Inc —Murfreesboro, TN
- Full-time
- Remote
- Microsoft Outlook
- Research
- Mid-level
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Revenue Cycle Specialist-Revenue Integrity - Pathology
Weill Cornell Medicine —New York, NY
- $32.69 - $36.76 an hour
- Remote
- Surgery
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- Mid-level
Clinical Denials and Appeals Specialist
UASI —Remote
- Remote
- Microsoft Word
- Nursing
- RN License
- Disability insurance
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14d
Remote Revenue Protection Specialist
Trinity Health —Livonia, MI
- $24.53 - $36.80 an hour
- Full-time
- Remote
- Mid-level
- 3 years
- High school diploma or GED
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Investigative Specialist 1 (Cannabis) (NY HELPS) - VID 219676
State of New York - Cannabis Management, Office of —New York, NY
- $53,764 - $85,138 a year
- Weekends as needed
- Remote
- Background check
- Management
- Mid-level
14d
Oncology Prior Authorization Specialist
Triarq Practice Services —Royal Oak, MI
- Full-time
- Remote
- Mid-level
Quick Apply
3d
Sr. Clinical Denials Appeal Specialist (Remote)
Stanford Health Care —Sacramento, CA
- $66.52 - $88.14 an hour
- Full-time
- Remote
- Nursing
- RN License
- Analysis skills
DRG Coder - (Hybrid)
IBERIA MEDICAL CENTER —Remote
- Full-time
- Remote
- Anatomy knowledge
- Word processing
- Bachelor of Science
AR Scpecalist
REVASCENT LLC —Meridian, ID
- $18 - $25 an hour
- Remote
- Mid-level
- Analysis skills
- Communication skills
Quick Apply
2d
Certified Coding Specialist
Spire Orthopedic Partners —Stamford, CT
- $31.95 - $39.95 an hour
- Full-time
- Remote
- 5 years
- Research
- Organizational skills
- Health insurance
- Dental insurance
Quick Apply
Director of ABA Revenue Cycle Management (Remote)
RightWay ABA —Clifton, NJ
- $100,000 - $150,000 a year
- Full-time
- Remote
- 6 years
- Analysis skills
- Mentoring
- Health insurance
- Dental insurance
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Senior Medicaid Compliance & Program Integrity Officer (Remote)
Guided Path Services —Remote
- $90,582.63 - $130,798.43 a year
- Part-time
- Remote
- 7 years
- HIPAA
- Analysis skills
Quick Apply
6d
Clinical Documentation Specialist
QHC ARM Shared Services, LLC —Brentwood, TN
- Full-time
- Remote
- Medicine
- LVN
- RN License
- Loan repayment program
- Health insurance
Quick Apply
Coding Specialist III
UT Southwestern —Dallas, TX
- 8 hour shift
- Remote
- Anatomy knowledge
- Surgery
- High school diploma or GED
- Paid parental leave
- Paid holidays

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Referral Authorization Specialist

Samaritan -
Washington, DC

Quick Apply

Job Details

Full-time
$21.24 - $28.84 an hour

Qualifications

Customer communication
High school diploma or GED

Full Job Description

Our Mission

All of us, for each of you, every time.

Our Vision

Together, serving as the trusted regional healthcare partner.

Our Values

Listen~Love~Respect~Excel~Innovate

Samaritan is searching for a Referral & Authorization Specialist to join our team! The Referral & Authorization Specialist is responsible for coordinating and securing prior authorizations, managing outgoing referrals, and ensuring compliance with payer requirements to support timely patient care and optimal reimbursement. This role serves as a critical liaison between providers, patients, payers, and internal departments to reduce denials, prevent delays in care, and ensure accurate documentation.

This is a full-time remote position that will be required to come on-site for onboarding and equipment pick-up (2 DAYS ONLY). This is a full-time role working Monday-Friday from 8:00 AM – 4:30 PM PST.

ESSENTIAL FUNCTIONS

Prior Authorization Management

Obtain prior authorizations for hospital and clinic services, including but not limited to, outpatient procedures, imaging, surgeries, and other specialty services.

Identify the health plan(s) by confirming information provided and verifying eligibility and coverage.

Verify payer requirements for authorization, referral, and medical necessity requirements based on plan guidelines.

Submit complete and accurate authorization requests with appropriate clinical documentation.

Track authorization status and follow up with the payer at regular intervals to ensure timely approvals.

Escalate urgent or complex cases to avoid delays in patient care.

Document authorization numbers, effective dates, and limitations in the EMR.

Communicate authorization delays and denials to ordering providers and clinics.

Monitor authorization workqueues and ensure timely completion.

Referral Management

Coordinate with providers and clinics to ensure appropriate scheduling and continuity of care.

Process outgoing referrals for specialty care.

Ensure referrals meet payer and regulatory requirements (e.g., PCP referrals, network rules).

Monitor referral workqueues and ensure timely completion.

Denial Prevention & Revenue Cycle Support

Review payer policies to ensure compliance and minimize denials.

Partner with coding, billing, and clinical teams to resolve authorization-related denials.

Inform department professionals and/or providers when peer-to-peer review is necessary. Assist as needed.

Assist with retro authorization requests and appeals as needed.

Identify trends and recommend process improvements.

Communication & Assistance

Serve as the point of contact for patients regarding referral and authorization status.

Communicate clearly with providers, clinical staff, payers, and patients.

Educate patients on authorization and referral procedures and next steps.

Maintain ongoing tracking and documentation for prior authorizations and referrals to promote team awareness.

Ensure HIPAA compliance when sharing patient information with authorized care providers.

General

Participate in continuing education opportunities.

Maintains professional growth and development through seminars, workshops and professional affiliations to keep abreast of latest trends in the field of expertise.

Ensures no injuries to self or others by following safe work practices and policies. This includes, but is not limited to: security and safety, understanding of chemical Safety Data Sheets (SDS), equipment, infection control, fire, disaster, safe lifting and body mechanics.

Ensures self-compliance with organization policies and procedures, as well as labor agreements.

Ensures the interface with team members and other support groups is conducted in a courteous and efficient manner conducive to the organization's values.

Conducts self in a professional manner and ensures personal appearance meets the standards necessary to perform the job function while representing the organization.

Ensures that additional accountabilities, as may be required by management, be handled in a manner necessary to meet organizational standards.

WORK ENVIRONMENT

The professional in this position reports to the Director of Revenue Cycle. Professionals in this position will work closely with patients and other Samaritan professionals within various departments.

EDUCATION & EXPERIENCE

Education:
- High school diploma or equivalent required; Associate degree preferred.
Experience:
- Minimum of two (2) years of experience in healthcare referrals, prior authorizations, or revenue cycle required.
- Experience working in a healthcare setting providing multi-specialty support preferred.
- Certified Healthcare Access Associate (CHAA) or similar certification preferred.
- Experience with Medicare, Medicaid (including Washington Apple Health), and commercial payers.
- Understanding of medical necessity criteria and utilization management.
Skills/Competencies:
- Strong knowledge of insurance plans, payer requirements, and authorization requirements.
- Familiarity with CPT, IDC-10, and medical terminology.
- Experience with EMR systems (EPIC) and payer portals (e.g., Availity, OneHealthPort, payer websites)
- Excellent organizational and time management skills.
- Ability to manage high-volume workqueues with attention to detail.
- Effective communication and interpersonal skills.
- Demonstrates competency on equipment listed on department specific checklist.
- Strong critical thinking skills: seeks resources for direction, when necessary. Performs independent problem solving. Decision-making is logical and deliberate.
- Performs actions that demonstrate accountability. Exercises safe judgment in decision-making. Practices within legal and ethical guidelines.
- Demonstrates competency in ability to care for customers/patients across the age continuum.

PHYSICAL REQUIREMENTS

Occasional lifting, reaching, kneeling, bending, stooping, pushing and pulling.

Occasional heavy lifting (lift/carry up to 50 lbs.).

Manual dexterity and mobility.

Ability to read and understand patient charts, provider orders, tests results, etc.

Ability to communicate using verbal and/or written skills for accurate exchange of information with physicians, nurses, health care professionals, patients and/or family, and the public.

As a Samaritan professional, you will be asked to carry out the Mission, Vision, Values, and Strategy of Samaritan, personifying service and operational excellence including the creation and maintenance of the best patient, professional, physician, and student experience.

Experience

Required

2 year(s): Experience in healthcare referrals, prior authorizations, or revenue cycle

Preferred

Experience with Medicare, Medicaid (including Washington Apple Health), and commercial payers.
Experience working in a healthcare setting providing multi-specialty support

Education

Required

High School or better

Preferred

Associates or better

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights (https://www.eeoc.gov/poster) notice from the Department of Labor.

Quick Apply

Refine Your Search

denial prevention specialist jobs in remote

Referral Authorization Specialist

Lead Clinical Documentation Specialist

Cash Posting Specialist - Healthcare (Full-time)

Workers Compensation Authorization & Verification Specialist

Senior Director, Revenue Cycle Management - REMOTE

Professional Billing Specialist

Account Reimbursement Specialist – Healthcare

Revenue Cycle Specialist-Revenue Integrity - Pathology

Clinical Denials and Appeals Specialist

Remote Revenue Protection Specialist

Investigative Specialist 1 (Cannabis) (NY HELPS) - VID 219676

Oncology Prior Authorization Specialist

Sr. Clinical Denials Appeal Specialist (Remote)

DRG Coder - (Hybrid)

AR Scpecalist

Certified Coding Specialist

Director of ABA Revenue Cycle Management (Remote)

Senior Medicaid Compliance & Program Integrity Officer (Remote)

Clinical Documentation Specialist

Coding Specialist III

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