Authorizations and Referrals Coordinator

Job Description

Job Description

AUTHORIZATIONS & REFERRALS COORDINATOR

Advanced Pain Solutions (APS) | Ky Advanced Surgery Center (KASC)

Department: Authorizations & Referrals
Reports To: Practice Administrator / Management
Position: Authorizations & Referrals Coordinator

Position Summary

The Authorizations & Referrals Coordinator is responsible for obtaining timely insurance authorizations, processing referrals, coordinating clinical documentation and provider note sign-offs, and assisting with scheduling approved procedures for both the medical practice and ambulatory surgery center.

A major responsibility of this position is maintaining consistent communication with providers, medical assistants, transcribers, and scheduling personnel to ensure clinical notes are completed and signed promptly so prior authorization (PA) requests can be submitted without unnecessary delays.

Essential Duties & Responsibilities

1. Insurance Authorizations

• Submit and obtain prior authorizations for office procedures, injections, imaging, surgical procedures, and other ordered treatments.
• Verify insurance eligibility, benefits, medical necessity criteria, and authorization requirements.
• Ensure correct diagnoses, CPT codes, and supporting clinical documentation accompany requests.
• Monitor pending authorizations daily and follow up with insurance carriers.
• Track approvals, denials, expiration dates, and authorized services.
• Assist with appeals, reconsiderations, and peer-to-peer review coordination.
• Communicate authorization updates promptly to appropriate staff.

2. Clinical Notes & Staff Communication

• Actively communicate with providers, transcribers, medical assistants, and appropriate staff to obtain completed and signed-off clinical notes needed for prior authorization submissions.
• Identify unsigned, incomplete, or missing clinical notes that may delay treatment or authorization requests.
• Follow up consistently with responsible staff until the required documentation is completed.
• Prioritize urgent notes for procedures awaiting authorization.
• Ensure signed documentation supports medical necessity and insurance requirements.
• Immediately escalate ongoing documentation delays to management.
• Maintain clear communication between authorizations, clinical staff, and scheduling to prevent interruptions in patient treatment plans.

3. Referral Processing & Coordination

• Process referrals for imaging, physical therapy, specialists, diagnostic testing, and other ordered services.
• Verify correct diagnoses, body parts, patient demographics, and supporting documentation.
• Ensure completed referrals are saved in the patient's electronic medical record.
• Submit referrals to appropriate facilities and provide patients with necessary referral information.
• Follow up on pending referrals and resolve missing or incorrect information.
• Communicate delays or discrepancies promptly to appropriate staff.

4. Procedure Scheduling & Coordination

• Assist scheduling staff with contacting patients and scheduling approved procedures at APS and KASC.
• Review authorization approvals to verify CPT codes, approved services, dates, and facility information before scheduling.
• Promptly communicate newly approved procedures to the scheduling team.
• Help maintain an organized list of approved procedures awaiting scheduling.
• Follow up with patients and scheduling staff to prevent approved procedures from remaining unscheduled.
• Coordinate scheduling priorities with management and clinical staff.
• Identify authorizations approaching expiration and assist with scheduling before approval deadlines.
• Communicate authorization changes, cancellations, or scheduling concerns immediately.

5. Documentation & Accuracy

• Verify complete and accurate ICD-10-CM and CPT codes on referrals and authorization requests.
• Review clinical documentation for completeness and required supporting information.
• Identify missing documentation and promptly request corrections.
• Document authorization numbers, insurance communications, reference numbers, and follow-up actions.
• Maintain organized and updated authorization and referral tracking records.

6. Denials & Follow-Up

• Investigate denied authorization requests and identify reasons for denial.
• Coordinate with providers and clinical staff to obtain additional supporting documentation.
• Submit reconsiderations and appeals when appropriate.
• Escalate urgent or unresolved issues to management.
• Follow all pending requests through approval, denial resolution, or appropriate closure.

7. Compliance & Communication

• Maintain compliance with HIPAA, insurance requirements, and company policies.
• Stay current with insurance authorization requirements and policy changes.
• Maintain timely communication with providers, transcribers, medical assistants, scheduling, and management.
• Respond promptly to emails and internal requests.
• Report recurring documentation, authorization, or scheduling delays.
• Support continuous improvement of referral and authorization workflows.

Qualifications

• Previous experience with medical authorizations, referrals, or insurance verification preferred.
• Knowledge of Medicare, Medi-Cal, commercial insurance, and workers' compensation requirements.
• Understanding of ICD-10-CM, CPT codes, medical terminology, and clinical documentation.
• Experience with electronic health records and practice management systems; eClinicalWorks experience preferred.
• Familiarity with pain management and interventional procedures preferred.
• Strong organizational, communication, time management, and problem-solving skills.
• Ability to coordinate effectively across multiple departments and manage deadlines.

Performance Expectations

• Submit accurate authorization requests and referrals promptly.
• Consistently follow up with appropriate staff to obtain signed-off clinical notes without unnecessary delays.
• Maintain daily oversight of pending authorizations, referrals, and missing documentation.
• Assist with scheduling approved procedures in a timely manner.
• Monitor approved procedures to help prevent authorization expiration before scheduling.
• Ensure accurate diagnoses, CPT codes, body parts, and supporting documentation.
• Promptly communicate delays, denials, approvals, and unresolved issues.
• Minimize treatment delays, claim denials, and procedure cancellations.
• Demonstrate accountability, professionalism, teamwork, and attention to detail.
• Support timely patient treatment, efficient scheduling, and the financial stability of APS and KASC.