Authorization & Referral Coordinator (ICD-9/10) On-site

Authorization & Referral Coordinator (ON-SITE)

Job Overview
We are seeking a detail-oriented and highly organized Authorization & Referral Coordinator to support the seamless delivery of healthcare services. This role is responsible for managing insurance eligibility, patient referrals, and pre-authorizations to ensure timely and compliant processing.

The ideal candidate will play a critical role in enhancing patient experience, expediting access to care, and supporting efficient reimbursement and cash flow operations.

Key Responsibilities:

Referral & Authorization Management

• Review daily clinic and surgical schedules to identify referral and pre-authorization requirements
• Prioritize referrals based on clinical urgency and provider availability
• Secure insurance authorizations for specialist consultations, diagnostics, procedures, and ASC services
• Coordinate and process pre-surgical authorizations in accordance with payer guidelines

Insurance Verification & Documentation

• Verify patient insurance eligibility and benefits prior to scheduled appointments
• Accurately document insurance information in the EHR/EMR system
• Resolve discrepancies by coordinating with patients, insurance providers, and internal teams

Interdepartmental Communication & Compliance

• Collaborate with clinics, providers, and call centers regarding referral and authorization status
• Ensure adherence to federal, state, and payer-specific guidelines
• Track co-payments, benefits, and coverage limits, particularly for recurring or specialty services

Record Maintenance & Digital Management

• Maintain accurate logs of authorizations and insurance communications
• Manage digital records through scanning, uploading, and faxing documents to the EHR
• Monitor pending referrals/authorizations and follow up to ensure timely completion

Knowledge Management

• Stay updated on payer requirements, workflows, and insurance policy changes
• Serve as a resource for internal teams on referral and authorization processes

Qualifications:

Required Skills & Competencies

• Strong attention to detail and organizational skills
• Excellent written and verbal communication skills with a professional and empathetic approach
• Ability to manage multiple priorities in a fast-paced environment
• Knowledge of insurance verification, prior authorization, and medical billing processes
• Proficiency in Google Workspace and ability to navigate multiple systems
• Familiarity with ICD-10, CPT codes, and billing modifiers
• Flexible and dependable; willing to work night shifts and on-site

Education & Experience:

• High school diploma or GED required
• Must be at least 1 year of experience in referral coordination, insurance verification, or healthcare administration
• Experience in ophthalmology or surgical scheduling is an advantage
• Working knowledge of ICD-10 and CPT coding standards and pre-authorization protocols (highly preferred)

Why Join Us?

• Be part of a collaborative healthcare team focused on patient-centered care
• Gain exposure to specialized processes in referrals and authorizations
• Opportunity to grow within a dynamic and supportive environment