Pride Health is hiring a Referral Navigator Rep. to support our client’s medical facility in Remote. This is a 3+ month contract assignment (convertible to permanent based on your work performance). and a great way to start working with a top-tier healthcare organisation!
Specific Duties:
Fax coordination for the Authorization Navigator Position
Process and manage prior authorization requests and referrals in accordance with payer guidelines and organizational policies.
Review clinical documentation to ensure completeness and support authorization submissions.
Verify patient eligibility, benefits, and coverage requirements across commercial, Medicare, and Medicaid health plans.
Communicate with insurance carriers, provider offices, and internal teams to obtain authorizations and resolve issues promptly.
Monitor authorization statuses and follow up on pending, denied, or incomplete requests to ensure timely patient care.
Apply knowledge of utilization management processes, payer requirements, and regulatory standards to support efficient operations.
Coordinate with healthcare providers, case managers, and managed care organizations to facilitate approvals and continuity of care.
Maintain accurate records of authorization activities, payer communications, and case outcomes within designated systems.
Ensure compliance with HIPAA regulations and confidentiality requirements when handling patient information.
Support health plan operations by identifying and addressing authorization-related barriers, escalating issues as needed.
Requirements:
2+ years of experience in prior authorizations, referrals, or healthcare operations.
Knowledge of insurance payer guidelines, authorization requirements, and medical terminology.
Experience coordinating referrals, authorizations, and healthcare documentation.
Strong organizational, multitasking, and communication skills in a fast-paced environment.
Familiarity with utilization management workflows, compliance standards, and audit processes.
What skills/attributes are nice to have, and will set a candidate apart?
Experience: 2–4+ years of experience in prior authorization processing, referrals, or healthcare operations Insurance Knowledge: Understanding of payer guidelines, authorization requirements, and basic medical terminology
Additional Information:
Location: Remote
Job Type: 3+ months contract to hire
Schedule: Monday - Friday
Office Hours: Shift in a window of 8 – 7
Pay Range: $12-13/hr. on W2
*Offered pay rate will be based on education, experience, and healthcare credentials.
#PHCUHGClinical $250
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PrideGlobal and it's affiliates offers eligible employee’s comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, pet insurance and employee discounts with preferred vendors.
Equal Employment Opportunity
PrideGlobal and it's affiliates are an equal opportunity employer. We do not discriminate on the basis of the race, religious creed, color, national origin, ancestry, physical disability, mental disability, reproductive health decision making, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, veteran or military status, or any other characteristic protected by applicable federal, state, or local law.
Fair Chance Employment
PrideGlobal and it's affiliates are a Fair Chance employer. We consider all qualified applicants, including those with criminal histories, in a manner consistent with applicable state and local Fair Chance laws and ordinances, including, the California Fair Chance Act and all applicable local Fair Chance ordinances.
Accommodations
We are committed to providing reasonable accommodations to applicants and employees with disabilities. If you require a reasonable accommodation to participate in the application or interview process, or to perform the essential functions of this role, please contact us.
Only applicable for San Francisco Candidates: Under the San Francisco Lactation in the Workplace Ordinance, we will provide written notice of lactation accommodation rights, and this notice will automatically be given upon hiring, any inquiry of parental leave or lactation accommodation.
Only applicable for Kentucky positions: For this type of employment, state law requires a criminal record check as a condition of employment. This applies to direct care staff (Examples: RN, LPN, Nurse Aides, Therapists) referred to Kentucky nursing facilities, assisted living communities, or long-term care facilities, in accordance with KRS 216.793.
