Referrals and Authorization Coordinator

Benefits 401(k) Dental insurance Health insurance Paid time off Vision insurance Position Summary The Referral & Authorization Coordinator is responsible for obtaining, tracking, and managing all insurance referrals, prior authorizations, and pre-certifications required for patient office visits, procedures, and surgeries. This role serves as a liaison between patients, providers, insurance companies, and external facilities to ensure timely approvals and uninterrupted patient care. The coordinator is responsible for maintaining compliance with payer requirements, minimizing authorization-related denials, and ensuring all scheduled services are properly authorized prior to the date of service. Essential Duties and Responsibilities Referral Management Obtain and verify referrals required for new and established patient office visits. Monitor referral expiration dates, visit limits, and authorization requirements. Communicate with referring providers to obtain necessary documentation and referral information. Ensure referrals are entered accurately into the EMR and linked to patient appointments. Follow up on missing referrals to prevent appointment delays or cancellations. Authorization Management Submit and obtain prior authorizations and pre-certifications for: Office visits In-office procedures Surgical procedures Outpatient and facility-based procedures Review clinical documentation for completeness prior to submission. Track authorization requests through completion and document status updates in the EMR. Obtain authorization extensions, modifications, or additional visits when required. Coordinate peer-to-peer reviews and appeal processes when necessary. Scheduling & Coordination Verify all referrals and authorizations are completed prior to patient appointments and procedures. Coordinate with providers, surgery schedulers, hospitals, and outside facilities to ensure authorization requirements are met. Communicate authorization approvals, denials, and pending statuses to patients and clinical staff. Maintain authorization logs and work queues to ensure timely follow-up. Insurance Verification & Compliance Verify patient insurance eligibility and benefits related to scheduled services. Maintain current knowledge of payer-specific authorization guidelines and requirements. Ensure compliance with Medicare, Medicaid, commercial insurance, and managed care plans. Accurately document all authorization numbers, approval dates, service dates, and payer communications. Denial Prevention & Resolution Identify authorization-related issues before services are rendered. Investigate and resolve authorization denials. Assist with appeals and resubmissions when appropriate. Work collaboratively with billing staff to reduce authorization-related claim denials and reimbursement delays. Qualifications High school diploma or equivalent required; medical office experience required. Minimum of 5 years of experience in medical referrals, authorizations, scheduling, or insurance verification. Knowledge of medical terminology, CPT codes, ICD-10 diagnosis coding, and payer authorization processes preferred. Experience with EMR systems and insurance portals. Strong organizational skills and attention to detail. Ability to manage multiple priorities and meet deadlines in a fast-paced environment. Excellent communication and customer service skills. Key Performance Expectations All referrals and authorizations completed prior to patient appointments and procedures. Maintain accurate and timely documentation of authorization activity. Minimize authorization-related appointment delays and cancellations. Reduce authorization-related claim denials through proactive verification and follow-up. Ensure timely turnaround of authorization requests according to payer requirements. Maintain a high level of patient satisfaction through effective communication and coordination. #J-18808-Ljbffr Pain Management