Referral Navigator Representative

Job Summary

A company is looking for a Referral Navigator Representative in Utilization Management.

Key Responsibilities:

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

Required Qualifications:

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