NEW JOB OPENING
PRIOR AUTHORIZATION & REFERRAL SPECIALIST
IN Remote, USA!

Required Education

• High School Diploma or equivalent



Required Experience

• 2–4+ years of experience in prior authorization processing, referrals, or healthcare operations.

• Experience working with payer guidelines and authorization requirements.

• Experience managing high-volume healthcare workloads and meeting turnaround time requirements.

• Experience reviewing authorization or referral requests and identifying missing or required information.

• Experience with EMR systems, authorization platforms, and Microsoft Office tools.



Required Skills

• Insurance Knowledge: Understanding of payer guidelines, authorization requirements, and basic medical terminology.

• Documentation Skills: Strong attention to detail with accurate and thorough documentation.

• Communication Skills: Ability to clearly communicate with providers, clinics, and internal teams.

• Time Management: Ability to manage high-volume workloads and meet turnaround time requirements.

• Critical Thinking: Ability to review requests and identify missing or required information.

• Technical Skills: Proficiency with EMR systems, authorization platforms, and Microsoft Office tools.



Preferred Skills

• Familiarity with compliance standards and audit processes.

• Experience with workflow improvements or training support.

• Strong organizational skills with the ability to prioritize competing tasks.

• Experience in a fast-paced, high-volume environment with a focus on accuracy and quality.

• Experience working with insurance plans, managed care organizations, or provider offices handling referrals and authorizations.

• Familiarity with utilization management workflows and payer requirements.



Job Duties

• Support prior authorization and referral processing activities.

• Review incoming authorization requests and supporting documentation.

• Identify missing or incomplete information required to process authorization requests.

• Coordinate with healthcare providers, clinics, and internal teams regarding authorization requirements.

• Accurately document authorization and referral activity within applicable systems.

• Apply payer guidelines and authorization requirements when reviewing requests.

• Manage a high-volume workload while meeting required turnaround times.

• Maintain accurate and thorough documentation.

• Support healthcare administration and health plan operations.

• Follow established utilization management workflows and payer requirements.



Typical Day

The Prior Authorization Navigation Representative will spend the majority of the day reviewing and coordinating authorization and referral requests. This includes reviewing documentation for completeness, identifying missing information, communicating with provider offices or internal teams, entering and updating information in authorization or EMR systems, and tracking requests through the appropriate workflow. The environment is fast-paced and production-driven, so candidates need to be comfortable balancing a high volume of requests while maintaining accuracy and meeting established turnaround times.

• **Only those lawfully authorized to work in the designated country associated with the position will be considered.**

• **Please note that all Position start dates and duration are estimates and may be reduced or lengthened based upon a client’s business needs and requirements.**