Referral/Authorization Specialist

About the role

Hyndman Area Health Center, a Federally Qualified Health Center (FQHC), is seeking a Referral Coordinator/Authorization Specialist to provide clinical support to healthcare providers in a busy medical facility.

Responsibilities

• Coordinate and maintain appointment schedules for employed healthcare providers to ensure efficient patient flow and continuity of care.
• Schedule referrals, specialty consultations, hospital appointments, diagnostic testing, and imaging services as ordered by providers, ensuring timely follow-up with patients, specialists, and healthcare facilities.
• Obtain and manage prior authorizations for referrals, medications, diagnostic imaging, and specialty services in accordance with insurance requirements and payer guidelines.
• Verify patient eligibility, insurance coverage, and benefits to facilitate authorization approvals and minimize delays in care.
• Review patient medical records, clinical documentation, and insurance information to support referral and authorization requests.
• Serve as a liaison between patients, providers, specialists, pharmacies, and insurance companies to coordinate care and resolve authorization or scheduling issues.
• Review payer guidelines and policies to ensure submitted authorization requests meet medical necessity and documentation requirements.
• Communicate with referring providers and clinical staff to obtain additional documentation and clinical information as needed to support referrals and authorization requests.
• Schedule diagnostic imaging and specialty appointments at patient-preferred facilities while ensuring compliance with provider recommendations and insurance requirements.
• Contact patients regarding scheduled appointments, referral status updates, authorization approvals, and care coordination needs; document all communications accurately within the electronic medical record (EMR).
• Process and track referral orders, imaging requests, prior authorizations, and approvals to ensure completion and timely follow-up.
• Maintain accurate and up-to-date patient demographic, insurance, and medical information within the electronic health record system.
• Scan, upload, and manage referral documentation, insurance authorizations, and supporting records within patient charts.
• Document all telephone encounters, referral activities, and patient communications according to organizational policies and medical record documentation standards.
• Answer incoming and outgoing telephone calls professionally, triaging patient inquiries and directing calls to appropriate clinical or administrative personnel.
• Greet patients and visitors courteously and assist with registration, check-in procedures, and referral-related questions when needed.
• Assist patients in overcoming barriers to care, including transportation needs, financial concerns, language barriers, and access to specialty services.
• Screen patients for medication adherence, social determinants of health, and barriers to care, facilitating patient engagement and appropriate follow-up services.
• Notify pharmacies and patients regarding medication authorization approvals and coordinate prescription-related communications.
• Prioritize incoming referral and authorization requests based on urgency, clinical need, and established department protocols.
• Educate patients regarding referral requirements, insurance benefits, authorization processes, and appointment expectations.
• Participate in quality improvement initiatives to improve referral completion rates, patient outcomes, and access to specialty care.
• Assist uninsured and underinsured patients with accessing specialty care programs, financial assistance resources, and community services.
• Generate reports related to referral status, authorization approvals, denials, and pending cases for leadership review.
• Support Patient-Centered Medical Home (PCMH) initiatives by promoting coordinated care, patient access, and quality outcomes.
• Ensure compliance with HIPAA regulations, payer requirements, and organizational policies while maintaining patient confidentiality and professionalism.

Benefits

• 401(k)
• 401(k) matching
• Competitive salary
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance
• Opportunity for advancement