Referral Navigator Representative

Job Summary

A company is looking for a Referral Navigator Representative to provide administrative support for the referral navigator department.

Key Responsibilities

• Coordinate with clinical staff to assist with the entry of prior authorization requests for utilization review
• Interpret and communicate covered benefits and exclusions, and manage prior authorization status requests
• Perform other duties as assigned

Required Qualifications

• High School diploma or GED from an accredited program
• 2+ years of managed care experience in a physician office or hospital setting
• Experience in creating authorization requests or billing Medicare or private insurance companies
• Knowledge of medical terminology, coding, COB payment, and prior authorization processes