Referrals & Authorization Clerk (74550)

About the role

The Referrals & Authorization Clerk is responsible for coordinating patient referrals, obtaining insurance authorizations, and ensuring timely and accurate communication between providers, patients, and external healthcare facilities. This position plays a critical role in maintaining continuity of care and supporting efficient clinic operations.

Responsibilities

• Process outgoing referrals in a timely manner.
• Verify completeness of referral orders (diagnosis, provider, documentation).
• Schedule appointments with specialists, imaging centers, or ancillary services.
• Ensure referrals meet payer requirements and guidelines.
• Obtain prior authorizations for procedures, imaging, and specialty visits.
• Verify patient insurance eligibility and benefits related to referrals.
• Communicate authorization approvals, denials, or additional requirements.
• Track authorization status and follow up as needed.
• Contact patients to provide referral details, appointment instructions, and required documents.
• Educate patients on referral processes and insurance requirements.
• Address patient questions regarding referrals and authorizations.
• Coordinate with referring providers, specialists, hospitals, and diagnostic facilities.
• Send necessary documentation (clinical notes, labs, imaging reports).
• Maintain professional relationships with external offices.
• Accurately document all referral activity in the EMR (Veradigm workflows).
• Maintain tracking logs for referrals and authorizations.
• Ensure all referral-related documentation is scanned and attached appropriately.
• Monitor referral work queues and resolve outstanding items.
• Ensure referrals comply with payer requirements and regulatory standards.
• Maintain confidentiality in accordance with HIPAA guidelines.
• Assist with audits or quality reviews related to referral processes.
• Demonstrate and embody the Women’s Care mission and core values.
• Other duties as assigned.

Qualifications

• High school diploma or equivalent required.
• Experience working with healthcare referrals, scheduling, or insurance verifications strongly preferred.
• Knowledge of medical terminology strongly preferred.
• Strong organizational and time management skills.
• Attention to detail and accuracy in documentation.
• Effective communication with patients, providers, and external facilities.
• Ability to manage multiple tasks in a fast-paced environment.
• Familiarity with EMR systems (preferably Veradigm) and insurance processes.
• Must be dependable, reliable, and punctual.

Benefits

• Competitive compensation package
• Health, dental, and vision benefits
• Paid time off and paid holidays
• 401k