The Eligibility and Authorization Specialist manages incoming and outgoing referrals, insurance eligibility verification, and prior authorizations through a consolidated electronic work queue structure.

This position serves as the point of intake for referral review and financial clearance before scheduling. The role ensures payer compliance, medical necessity validation, CPT accuracy, and closed-loop referral tracking to improve patient access, reduce denials, and protect revenue integrity.

QUALIFICATIONS:

Specific Job Skills

1. Ability to manage high-volume consolidated work queues
2. Strong analytical skills and attention to detail
3. Understanding of medical necessity standards
4. Excellent written and verbal communication skills
5. Ability to enforce standardized workflow policies
6. Strong time management and prioritization skilld
7. Customer service skills
8. Ability to escalate appropriately within defined structure
9. Commitment to compliance and patient confidentiality

Education

1. High School Diploma or GED required
2. Associate’s or Bachelor’s degree preferred
3. CPC certification required within 18 months 

Experience

1. Healthcare revenue cycle, referral, or authorization experience preferred
2. Experience managing EHR work queues
3. Knowledge of ICD-10 and CPT coding
4. Familiarity with CMS and payer authorization requirements
5. Experience in centralized processing environments preferred

Shift: Full time, M-F, 8 or 10 hour shifts

SALARY: $26.65 - $42.59/hour DOE