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Referral Specialist II, Columbia, South Carolina

CategoryCustomer Service
Job typeFull-Time
CountryUnited States of America
StateSouth Carolina
Position Purpose: Assist in monitoring utilization of medical services to assure cost effective use of medical resources through processing prior authorizations and act as trainer and mentor to less experienced staff.

  • Provide technical support to staff and provide ongoing training.
  • Initiate authorization requests for output or input services in keeping with the prior authorization list.
  • Research claims inquiry specific to the department and the responsibility.
  • Process referrals and refer, when appropriate to Case Managers.
  • Screen for eligibility and benefits. Answer phone queues and faxes within established standards.
  • Data enters authorizations into the system.

  • Qualifications:

    Education/Experience: High school Diploma or equivalent. Bilingual in Spanish preferred. 3+ years of customer service experience. Knowledge of medical terminology preferred.

    Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
    EmployerCentene Corporation

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