Authorization and Referral Coordinator - Remote

Overview

The Authorization and Referral Coordinator plays a vital role in ensuring that all necessary authorizations and referrals are obtained before the date of service. This position requires close coordination with healthcare providers, insurance companies, and patients to ensure compliance with payer requirements, reduce claim denials, and create a seamless patient experience.

In Short

• Verify the need for prior authorization for scheduled procedures, diagnostic tests, and specialty services based on insurance requirements.
• Submit authorization requests with complete and accurate documentation.
• Monitor authorization status and follow up with payers to ensure timely approvals.
• Communicate authorization outcomes to patients, providers, and scheduling staff.
• Confirm referral requirements based on patients’ insurance plans and provider contracts.
• Request and obtain referrals from primary care providers (PCPs) or referring specialists.
• Track referral approvals and ensure proper documentation in the EHR system.
• Inform patients of any authorization or referral requirements before their appointments.
• Work closely with scheduling, clinical, and billing teams to prevent delays due to authorization or referral issues.
• Accurately document all authorization and referral activities in the EHR system.

Requirements

• Strong understanding of Medicaid, Medicare, and commercial payers' policies.
• Proficiency in EHR and practice management systems, as well as knowledge of CPT, ICD-10, and HCPCS codes.
• Excellent verbal and written communication skills for interacting with patients, providers, and insurance companies.
• Ability to address and resolve authorization and referral issues efficiently.
• Strong organizational skills to manage high-volume workflows accurately.
• High school diploma or GED required; Associate’s degree in Healthcare Administration, Business, or related field preferred.
• Minimum 2 years of experience in prior authorization, referrals, or healthcare administrative support.
• Certification in medical billing or coding (e.g., CPC, CCA) is preferred.
• Experience with payer portals and authorization tools is a plus.
• Experience with NextGen a plus.

Benefits

• PTO Accruals Start at 3 Weeks
• Comprehensive Medical and Dental Insurance
• Company-Paid Optical Allowance
• Company-Paid Routine Eye Care
• Short-Term and Long-Term Disability Insurances
• Educational Allowance
• Paid Holiday Program
• 401K with Company Match