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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in processing insurance pre-authorizations and coordinating referrals while ensuring accurate documentation and compliance with regulatory requirements. Proficient in collaborating with clinical staff and insurance representatives to advocate for patients and facilitate timely approvals.
Highest-signal resume keywords
Insurance Pre-Authorization ProcessingElectronic Medical Records (EPIC)Referral CoordinationMedical Terminology KnowledgeBilingual Spanish
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Insurance VerificationData EntryCost EstimationDocumentation ManagementPatient Advocacy
Soft Skills
CollaborationClear CommunicationDetail-OrientedTeamworkProfessional Writing
Tools & Technologies
Microsoft WordMicrosoft OutlookMicrosoft ExcelMicrosoft OneNoteInsurance Platforms
Certifications & Qualifications
CNAMAEMT
Industry Keywords
HealthcareInsurance CarriersPatient ServicesReferral ManagementFinancial Counseling
About the role
Key responsibilities & impact- Process insurance pre-authorizations for primary and specialty service visits and testing
- Gather information from patients, providers, insurance carriers, and staff to confirm financial obligations
- Act as liaison between clinical staff, health plans, providers, and patients
- Verify insurance coverage and obtain required authorizations
- Document referral information, communications, actions, and authorization progress in electronic medical systems
- Process internal, external, and outbound referrals through electronic medical records
- Assemble, research, and triage patient demographic, insurance, and medical information
- Track referrals and maintain detailed documentation to promote team awareness and patient safety
- Route inbound referrals according to regulatory and specialty department requirements
- Coordinate prior-authorization details for visits and procedures
- Coordinate provider peer-to-peer interactions for insurance approvals
- Generate cost estimates and direct patients to financial counseling resources
- Contact insurance representatives or contracted review organizations and present medical information
- Advocate for patients to obtain timely approval of necessary services
- Collaborate with Patient Service Representatives, Clinical Staff, and Payer Relations
- Provide documentation for denials and appeals
- Use insurance platforms and medical records systems for accurate data entry, retrieval, and reporting
- Meet performance standards and volume metrics while aligning with organizational values
Requirements
What you’ll need- Computer literacy ensuring accuracy and timeliness
- Ability to work well with coworkers and patients
- Ability to collaborate with multiple teams
- Ability to write clearly and professionally
- Thorough, precise, and detail-oriented work style
- Knowledge of Microsoft Word, Outlook, Excel, and OneNote
- Medical terminology knowledge preferred
- Experience with electronic medical records (EPIC) preferred
- CNA, MA, EMT, healthcare, or health plan experience preferred
- Referral coordination experience preferred
- Bilingual Spanish preferred
- Ability to meet physical requirements, including frequent computer use, communication, lifting, walking, and transporting patients or supplies
- Ability to work Monday–Friday during business hours
- Must reside outside California, Connecticut, Hawaii, Illinois, Massachusetts, Minnesota, New York, Pennsylvania, Rhode Island, Vermont, Virginia, and Washington
Benefits
Comp & perks- Benefits eligible
- Generous benefits package covering programs for wellness, health, security, connection, and engagement
- Flexible work options where approved and stated in the job posting
- Company equipment and remote-work support referenced in remote work expectations