Prior Authorization Specialist

our privacy is important to us. All applications are strictly confidential.

Refuah Health is a federally qualified health center offering comprehensive care in Rockland and Sullivan Counties. We are over one hundred healthcare professionals strong with three decades’ experience providing unparalleled patient care. As an FQHC, we specialize in accessible and affordable care for low income and high-risk residents. We believe in the power of people to create great care and we are inviting the best to build their career with us!

Why Refuah?

• Join a collegial team of coworkers.
• Five modern state of the art facilities.
• Flexible schedules for maximum work-life balance.
• No experience required. Full training provided.

The Prior Authorization Specialist is responsible for obtaining pre-certifications and authorizations for Refuah patients. They take ownership and serve as the last line of defense against errors.

Duties and responsibilities:

1. Contact insurance companies to verify benefits eligibility
2. Collaborate with Refuah providers to resolve and appeal denied authorizations
3. Ensure all services have prior authorizations. Utilize EMR system checking encounters when necessary and assign to the appropriate provider.
4. Maintain knowledge of Medicaid and third party insurance requirements
5. Verify insurance for in-network or out-of-network benefits
6. Pre-certify services including surgery, office visits, diagnostic testing or any procedure that requires pre-certification
7. Review Pediatric referrals from previous day and help schedule appointments
8. Maintain strict patient confidentiality
9. Maintain authorization records documentation
10. Complies with applicable policies and procedures and supports the Compliance Program
11. Contributes to organizational operations by performing other duties as may be required