Authorization & Referrals Coordinator
Core
Secures prior authorizations and primary care referrals for professional and hospital technical services across inpatient and outpatient care to facilitate timely access and support reimbursement.
Role type
Authorization & Referrals Coordinator
Builds
Timely access to care and accurate reimbursement for inpatient and outpatient services
Domain
Healthcare administration / Insurance verification
Deliverable
dashboards & analysis
Required skills
Medical terminology, Insurance verification, Payer guidelines (Medicare/Medicaid/commercial), EHR/EMR systems, Data integrity, Multi-tasking
Preferred skills
Associate's degree, Authorization experience
Responsibilities
Ensures timely follow-up on pending authorizations to prevent treatment delays; Collaborates with clinical and scheduling teams regarding authorization status; Obtains and documents prior authorizations and referrals for all required services; Verifies insurance eligibility and benefits for patients; Verifies accuracy of referring provider to ensure data integrity; Serves as liaison between providers, patients, and insurance companies to resolve issues.