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Referral & Authorization Specialist
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Nature Coast Primary Care , LLC
Crystal River, FL (In Person)
$37,440 Salary, Full-Time
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Job Description
Position Summary We are seeking a detail-oriented and highly organized Referral & Authorization Specialist to join our growing medical practice. This role is critical to ensuring patients receive timely, coordinated care by accurately processing referrals and obtaining insurance authorizations in compliance with payer and regulatory requirements. The ideal candidate is proactive, communicates effectively, and thrives in a fast-paced healthcare environment. Key Responsibilities Process and manage outgoing referrals to specialists, diagnostic facilities, and ancillary services
- Obtain prior authorizations for procedures, imaging, and specialty visits as required by insurance plans
- Verify patient insurance benefits and authorization requirements
- Submit authorization requests via payer portals, phone, and fax
- Track authorization status and follow up to ensure timely approvals
- Communicate authorization outcomes to patients, providers, and external offices
- Maintain accurate documentation in the EMR and referral tracking systems
- Fax medical records and referral documentation to outside providers promptly
- Identify authorization denials and work with clinical staff to resolve issues
- Ensure compliance with HIPAA and organizational policies
- Collaborate closely with front desk, clinical staff, and providers to support continuity of care Qualifications High school diploma or equivalent required (Associate degree preferred)
- Minimum 1-2 years experience in medical referrals and insurance authorizations
- Strong knowledge of Medicare, Medicare Advantage, and commercial insurance plans Familiarity with prior authorization processes for imaging, specialty care, and procedures
- Experience using EMR systems
- Excellent attention to detail and organizational skills
- Strong verbal and written communication skills
- Ability to manage multiple tasks and meet deadlines in a busy clinical setting
- Professional, patient-focused demeanor Preferred Skills Experience in primary care or specialty medical practice
- Knowledge of value-based care workflows
- Bilingual (English/Spanish) a plus
- Ability to independently prioritize workload and follow through without constant supervision Why Join Us Supportive leadership and team-oriented environment
- Stable, growing medical practice
- Opportunity to make a direct impact on patient care and outcomes
- Competitive pay based on experience
- Benefits package available for full-time employees