Referrals & Authorizations Coordinator - FT - Days - MHW

Responsibilities

• Serves as liaison between providers, patients, and insurance companies to resolve authorization and/or referral-related issues.
• Verifies accuracy of referring provider to ensure data integrity and accuracy.
• Verifies insurance eligibility and benefits for patients, including coverage for specialty medications and services.
• Processes incoming and outgoing referrals from providers, ensuring appropriate documentation and approvals are in place.
• Obtains and documents prior authorizations and referrals for all required services.
• Understands and applies payer-specific guidelines, including Medicare, Medicaid, and commercial insurance requirements for both practice and hospital billing.
• Collaborates with clinical and scheduling teams regarding authorization status to support treatment planning and scheduling.
• Safeguards timely follow-up on pending authorizations to prevent treatment delays.

Competencies

• ACCOUNTABILITY, ACCURACY & QUALITY
• CUSTOMER SERVICE
• DESKTOP SOFTWARE - EHR
• EFFECTIVE COMMUNICATION
• HIPAA
• INSURANCE VERIFICATION
• MANAGE BUSINESS PRIORITIES
• ORGANIZATION SKILLS
• PATIENT AND FAMILY CENTERED CARE
• PROBLEM SOLVING
• PRODUCTIVITY
• RESPONDING TO CHANGE
• STANDARDS OF BEHAVIOR
• TEAM WORK
• VERIFY INSURANCE
• WORKLOAD MANAGEMENT

Education And Certification Requirements

• A high school diploma or equivalent is required.
• An associate’s degree is preferred.

Additional Job Information

• Complexity of Work: Knowledge of medical terminology, and insurance authorization processes.
• Familiarity with payer portals, EMR systems, and healthcare billing systems.
• Strong interpersonal and communication skills with attention to detail.
• Ability to manage multiple tasks in a fast-paced environment.

Required Work Experience

• A minimum of two (2) years’ experience in medical practice, preferably in a setting with authorization experience.

Other Information

• Additional Education Information: An associate’s degree is preferred.
• Working Conditions And Physical Requirements: Bending and Stooping = 0%, Climbing = 0%, Keyboard Entry = 60%, Kneeling = 0%, Lifting/Carrying Patients 35 Pounds or Greater = 0%, Lifting or Carrying 0 - 25 lbs Non-Patient = 60%, Lifting or Carrying 2501 lbs - 75 lbs Non-Patient = 0%, Lifting or Carrying > 75 lbs Non-Patient = 0%, Pushing or Pulling 0 - 25 lbs Non-Patient = 0%, Pushing or Pulling 26 - 75 lbs Non-Patient = 0%, Pushing or Pulling > 75 lbs Non-Patient = 0%, Reaching = 40%, Repetitive Movement Foot/Leg = 0%, Repetitive Movement Hand/Arm = 0%, Running = 0%, Sitting = 20%, Squatting = 0%, Standing = 0%, Walking = 0%, Audible Speech = 0%, Hearing Acuity = 0%, Smelling Acuity = 0%, Taste Discrimination = 0%, Depth Perception = 0%, Distinguish Color = 0%, Seeing - Far = 60%, Seeing - Near = 0%, Bio hazardous Waste = 0%, Biological Hazards - Respiratory = 0%, Biological Hazards - Skin or Ingestion = 0%, Blood and/or Bodily Fluids = 0%, Communicable Diseases and/or Pathogens = 0%, Asbestos = 0%, Cytotoxic Chemicals = 0%, Dust = 20%, Gas/Vapors/Fumes = 0%, Hazardous Chemicals = 0%, Hazardous Medication = 0%, Latex = 0%, Computer Monitor = 60%, Domestic Animals = 0%, Extreme Heat/Cold = 0%, Fire Risk = 0%, Hazardous Noise = 0%, Heating Devices = 0%, Hypoxia = 0%, Laser/High Intensity Lights = 0%, Magnetic Fields = 0%, Moving Mechanical Parts = 0%, Needles/Sharp Objects = 0%, Potential Electric Shock = 0%, Potential for Physical Assault = 0%, Radiation = 0%, Sudden Decompression During Flights = 0%, Unprotected Heights = 0%, Wet or Slippery Surfaces = 0%, Shift Primarily for office workers - not eligible for shift differential.