Referral Authorization Specialist

Referral Authorization Specialist

General Job Summary: The Referral Authorization Specialist will be responsible for managing referrals from the practice to other facilities or service providers and incoming action referrals from other service providers.

• Complete all referrals for the clinics and ensure they are processed effectively, making sure they are sent to the correct department.
• Responsible for prioritizing Stat Referral Authorizations.
• Follow up on sent referrals.
• Review patient benefits and eligibility to communicate with clinician and clinical staff pertaining to authorization.
• Keep the system up to date with any changes in information.
• Manage referral status to ensure clinics have all updated and current information.
• Completes referrals for patients and coordinates with referring and receiving practices and/or departments.
• Obtains and maintain prior authorizations for diagnostic and ancillary testing.
• Handle sensitive information in a confidential manner.
• All other duties as assigned.

Clinic Support responsibilities include:

• Compiles patients’ health information including patient symptoms and medical history, exam results, X-ray reports, lab tests, diagnoses, and treatment plans.
  • Ensures all related reports, labs and demographics are sent to the outside facility prior to their appointment.
  • Reviews to ensure all forms are completed, properly identified, and signed and that all necessary information in the EHR.
• Communicates as needed with physicians and other health care professionals to clarify diagnoses or obtain additional information.
• Obtains lab/X-ray reports, hospital notes, referral information, etc.;
• Verifies insurance coverage and patient demographics;
• Updates charts to ensure that information is complete and filed appropriately.
• Ensures timely delivery of outside mail and communication to the physician

• High School Diploma or GED required.
• Minimum 2 years’ experience in a health coordination role.
• Demonstrated understanding of industry guidelines and best practices.
• Thorough understanding of insurance coverage and Medical Necessity policies.
• Customer service experience required.
• Knowledge of medical records software preferred.
• Completion of Hepatitis B Vaccine and Flu Vaccine Form will be required. Candidate may decline vaccination through declination form or may provide record of vaccination from previous employer.

• Completion of TB test will be required.

Physical Requirements:

• Work consistently requires walking, standing, sitting, lifting, reaching, stooping, bending, pushing, and pulling.
• Must be able to lift and support weight of 35 pounds
• Ability to concentrate on details.
• Use of computer for long periods of time.