Referral/Authorization Specialist

Job Description

Job Description

Benefits:

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

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.

Referral/Authorization Specialist

• 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.

HAHC is an Equal Opportunity Employer. We do not discriminate based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, genetic information, or any other status protected by law.