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Responsibilities

The Referral Navigator Representative provides administrative support for the referral navigator department. This position is primarily responsible for coordinating with KS clinical staff to assist with the entry of prior authorization requests for utilization review. This includes interpretation and communication of covered benefits and exclusions, prior handling and appropriately directing prior authorization status requests received from KSC staff and assisting with requesting clinical updates. Other duties as assigned.

Job Title: Referral Navigator Representative

Location: Pearland Administrative Office

Department: Utilization Management

Job Type: Full Time

Salary Range: $ 35,240 - $43,535 (Pay is based on several factors including but not limited to education, work experience, certifications, etc.)

Qualifications

Education

Required: High School diploma or GED from an accredited program

Preferred: Graduate from accredited medical assistant program

Experience

Required: 2 –3 years of managed care experience either in a physician office or hospital setting health plan,

ACO, or other managed care setting.

Experience in creating authorization requests or billing Medicare or private insurance companies.

Preferred: Knowledge of CPT & ICD 10 Coding methodologies and billing.

Prior experience with precertification and/or utilization management.

Knowledge of insurance payer specific prior authorizations requirements preferred.

License(s)

Required: N/A

Preferred: Certified medical assistant

Special Skills

Required: Knowledge of medical terminology, coding, COB payment, and prior authorization processes.

Alpha/numeric data entry and basic PC Literacy.

Demonstrate a working knowledge of industry standards processing.

Understanding of Health plan benefits and financial obligation interpretation

Preferred: Strong knowledge of HMO, PPO, and POS plan types a plus including Medicare and commercial

health plans.

Benefit interpretation a plus

Other

Required: Excellent verbal communication and time management skills

Preferred: N/A

Working Environment: Office

About Us

Start your career journey and become a part of a community of renowned Healthcare professionals. Kelsey-Seybold Clinic is Houston’s fastest growing, multispecialty organization with more than 40 premier locations and over 65 specialties. Our clinics are comprised of more than 600 physicians and as we continue to grow, our focus is providing quality patient care by adding to our team of clinical and non-clinical professionals that work together in a convenient, coordinated, and collaborative manner. Enjoy the rewards of a successful career while maintaining a work/life balance by joining our team today and changing the way health cares.

Why Kelsey-Seybold Clinic?

• Medical, Vision, and Dental

• Tuition Reimbursement

• Company Matching 401K

• Employee Reward and Recognition Program

• Paid time off for vacation, sick, and holidays

• Employee Assistance Program

• Continuing Medical Education allowance

Kelsey-Seybold Clinic strives to provide equal opportunity employment without regard to race, color, religion, age, national origin, sex, gender, sexual orientation, gender identity/expression, genetic information, disability, veteran status, or any other basis protected by organizational policy or by federal, state, or local laws unless such distinction is required by law. Kelsey-Seybold is a VEVRAA Federal Contractor and desires priority referrals of protected veterans.