Authorization & Referrals Coordinator

Location:

Pembroke Pines Florida

At Memorial we are dedicated to improving the health well-being and most of all quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience.

Summary:

The Referrals and Authorizations Coordinator secures prior authorizations and primary care referrals for both professional and hospital technical services across inpatient and outpatient care including surgeries procedures and specialist visits. This role facilitates timely access to care minimizes treatment delays and supports accurate reimbursement through payer compliance.

Responsibilities:

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

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:

High School Diploma or Equivalent (Required)

Additional Job Information:

Complexity of Work: Knowledge of medical terminology and insurance authorization with payer portals EMR systems and healthcare billing interpersonal and communication skills with attention to to manage multiple tasks in a fast-paced Work Experience: A minimum of two (2) years experience in medical practice preferably in a setting with authorization Information: Additional Education Information: Associates degree 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

Disclaimer: This job description is not intended nor should it be construed to be an exhaustive list of all responsibilities skills efforts or working conditions associated with the job. It is intended to indicate the general nature and level of work performed by employees within this classification.

Wages shown on independent job boards reflect market averages not specific to any employer. We encourage candidates to talk to their Memorial Healthcare System recruiter to discuss actual pay rates during the hiring process.

Memorial Healthcare System is proud to be an equal opportunity employer committed to workplace diversity.

Memorial Healthcare System recruits hires and promotes qualified candidates for employment opportunities without regard to race color age religion gender sexual orientation national origin veteran status disability genetic information or any factor prohibited by law.

We are proud to offer Veterans Preference to former military reservists and military spouses (including widows and widowers). You must indicate your status on your application to take advantage of this program.

Employment is subject to post offer pre-placement assessment including drug testing.

If you need reasonable accommodation during the application process please call (M-F 8am-5pm) or email

Required Experience:

IC