Authorization and Referral Specialist (2026-0779)

Job Overview

The Authorization and Referral Specialist is responsible for supporting the Lifestyle Medicine and Outpatient Rehabilitation service lines by providing treatment authorization, insurance verification, benefit summaries, scheduling, and referral management for all clinical services. Works closely with Patient Financial Services, Admitting Registrars, providers, insurance companies, and patients to ensure seamless coordination of services.

Department: Lifestyle Medicine and Outpatient Rehabilitation

Reports to: Lifestyle Medicine/Outpatient Rehabilitation Supervisor, Manager or Director

Work Schedule

Typically Monday – Friday, 8:00 am to 5:00 pm or as needed to meet department needs.

Pay

Salary range: $22.04 – $31.96 per hour, depending on experience.

Prerequisites

• High School graduate or equivalent (G.E.D.) required.
• Minimum three (3) years of experience in a related medical and/or insurance industry.
• Knowledge of medical terminology and abbreviations.
• Basic keyboarding skills and proficiency with Windows and Microsoft applications.
• Prior experience using practice management and electronic medical record systems.
• Epic experience preferred.

Qualifications

• Demonstrated knowledge of clinical ICD‑10, CPT, and HCPCS coding.
• Professional written and verbal communication skills across all mediums.
• Strong problem‑solving ability with independent decision‑making skills.
• Ability to function independently and manage time effectively.
• Capability to access, analyze, and apply concepts associated with protocol, policy, and guidelines.
• Excellent analytical, critical‑thinking, and attention‑to‑detail skills.
• Ability to recognize and interpret clinical documentation pertinent to prior authorizations.
• Proficiency with multiple computer tools and software packages, including:
  • Utilizing multiple monitors for workflow management.
  • Healthcare websites and provider portals.
  • Business practice management systems.

Physical & Mental Demands

• Legible writing and computer/keyboard proficiency required.
• Excellent telephone etiquette essential.
• Regular and punctual attendance is a condition of employment.
• Maintain composure and a positive attitude under stress.
• Flexible scheduling and extended hours as needed.
• Effective problem‑solving and conflict‑resolution skills.
• Ability to organize, prioritize, and handle multiple demands simultaneously.
• Comfortable with continual change; able to assimilate new information for daily operations.

Key Responsibilities

• Plan, direct, and manage a high volume of treatments requiring referral management, scheduling, and prior authorization.
• Collaborate within an integrated team of Patient Access, Patient Financial Services, providers, and admitting registrars.
• Work with department leadership and clinical staff to ensure safe, efficient, professional, and patient‑centered care.
• Apply knowledge of clinic structure, standards, procedures, and guidelines to deliver consistent, high‑quality services.
• Maintain department‑specific records, update, and verify patient data in the EMR.
• Referral Management & Scheduling:
  • Organize and manage referral work queues within the EMR.
  • Coordinate referrals to Lifestyle Medicine and Outpatient Rehabilitation services and collaborate with Admitting Registrars on scheduling.
  • Contact patients via manual and automated systems to process referrals, register, and schedule appointments.
• Insurance Verification & Authorization:
  • Contact insurance companies via portals and phone to obtain benefit verification and prior authorizations for treatments (e.g., physical, occupational, speech therapy, cardiac and pulmonary rehab, nutrition, diabetes education, and other Lifestyle Medicine programs).
  • Organize, pre‑authorize, and distribute authorizations promptly to all stakeholders.
  • Monitor insurance policy updates to stay current on ICD‑10 and HCPCS pre‑authorization requirements.
  • Communicate insurance benefits, authorizations, and billing processes to patients.
  • Coordinate benefits and explore payment options to secure accounts.
  • Resolve insurance denials and collaborate with billing to ensure proper coding and documentation.
  • Inform management of changes in pre‑authorization requirements and potential barriers.
• Follow formal chain‑of‑command guidelines in all duties.
• Complete projects and other duties as assigned.