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Prior Authorization & Referral Specialist (Part-Time)
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Bliss Specialty Healthcare Group
Orlando, FL (In Person)
$39,520 Salary, Part-Time
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Job Description
Job Summary Bliss Specialty Healthcare Group is seeking an experienced Prior Authorization & Referral Specialist to join our growing healthcare team. We provide Primary Care, Wound Care, Psychiatry, and Chronic Care Management services throughout Florida in Assisted Living Facilities (ALFs), Skilled Nursing Facilities (SNFs), Memory Care Communities, and patient homes. We are looking for a highly organized individual who can manage insurance authorizations, referrals, eligibility verification, and coordination of care while ensuring timely approvals and reducing denials. Position Type Part-Time Prior Authorizations Submit, track, and obtain prior authorizations for: Wound care services Debridement procedures Negative Pressure Wound Therapy (Wound Vac) Psychiatry services Psychological testing Specialist consultations Diagnostic testing and imaging Monitor authorization status and follow up with insurance companies. Request extensions and renewals for ongoing treatment plans. Maintain accurate authorization records in ECW and tracking systems. Referrals Process incoming and outgoing referrals. Coordinate referrals to specialists, home health agencies, therapy providers, and diagnostic services. Ensure all required documentation is submitted timely. Follow up on referral status and obtain consultation reports. Insurance Verification Verify patient eligibility and benefits. Confirm PCP assignment and referral requirements. Determine authorization requirements before scheduling services. Identify payer-specific requirements and coverage limitations. Administrative Support Maintain authorization and referral logs. Communicate authorization status to providers, medical assistants, schedulers, and billing staff. Assist with resolving authorization-related claim denials. Upload and organize documents within the EMR. Qualifications Minimum 2 years of prior authorization and referral coordination experience. Experience working with Medicare Advantage plans. Knowledge of insurance verification and authorization processes. Familiarity with CPT and ICD-10 coding. Strong attention to detail and organizational skills. Ability to manage multiple tasks and meet deadlines. Excellent communication and follow-up skills. Preferred Qualifications Experience with wound care authorizations. Experience with Medicare Advantage plans including Humana, UnitedHealthcare, Aetna, CarePlus, Freedom, Optimum, and Florida Blue. Experience using eClinicalWorks (ECW). Experience working in home-based, ALF, SNF, or specialty care practices.