Referral/Prior Authorization Coordinator

The Referral Coordinator serves as the primary liaison between patients referring practices and insurance companies to facilitate access to care and ensure seamless communication regarding clinical services. Operating under general supervision this role is responsible for the coordination of pre-admission registration and scheduling for inpatient ambulatory and emergency department patients requiring surgical or interventional studies. The position ensures financial clearance and operational efficiency to support the departments clinical and strategic goals. Patient Registration and Financial Clearance: Conducts interviews with patients families and referring providers to collect accurate demographic and financial data. Verifies third-party insurance coverage including workers compensation and motor vehicle accident claims to ensure proper reimbursement.
Referral and Authorization Management: Obtains necessary prior approvals and authorizations from managed care organizations before services are rendered. Documents authorization details in the hospital registration system and communicates coverage alternatives or denials to patients and clinical staff.
Surgical and Clinical Scheduling: Coordinates the scheduling of surgical cases and follow-up appointments by analyzing O.R. availability anesthesia requirements and specialty instrument needs. Manages last-minute changes such as emergencies or cancellations to maintain optimal patient flow.
Insurance and Regulatory Compliance: Verifies medical necessity for procedures using designated software and performs day-of-service eligibility checks. Assigns medical record numbers and updates the Master Patient Index (MPI) to maintain data integrity.
Administrative Resource and Liaison: Serves as a subject matter expert for clinical and administrative staff regarding managed care guidelines. Attends orientations by payers to operationalize new procedures and trains practice staff on updated referral protocols. Initiates work/repair orders uses computer software /terminal for access data entry. Log issues with the ITS rounder or to the help desk. Arranges for delivery of expired/broken equipment/materials to appropriate repair site. Tracks and returns borrowed/rented equipment.
Data Monitoring and Reporting: Generates and reviews automated reports on billing edits registration quality and patient no-shows. Identifies inefficiencies in the referral process and collaborates with the Practice Manager to implement corrective actions.
Patient Access Coordination: Facilitates urgent surgical appointments and cross-books ancillary services such as social work interpreters and radiology. Directs patients to financial counseling for assistance with free care applications and collects required co-

Compensation Range:
$19.95- $27.88 This range offers an estimate based on the minimum job qualifications. However our approach to determining base pay is comprehensive and a broad range of factors is considered when making an offer. This includes education experience skills and certifications/licensures as they directly relate to position requirements; as well as business/organizational needs internal equity and addition BMCHS offers generous total compensation that includes but is not limited to benefits (medical dental vision pharmacy) discretionary annual bonuses and merit increases Flexible Spending Accounts 403(b) savings matches paid time off career advancement opportunities and resources to support employee and family well-being.
NOTE : This range is based on Boston-area data and is subject to modification based on geographic location.

Equal Opportunity Employer/Disabled/Veterans
According to the FTC there has been a rise in employment offer scams. Our current job openings are listed on our website and applications are received only through our website. We do not ask or require downloads of any applications or apps job offers are not extended over text messages or social media platforms. We do not ask individuals to purchase equipment for or prior to employment.
Required Experience:
IC