Authorization & Referral Coordinator

Bay Area Hospital•Fort Bridger, WY

1d•$27 - $35

About The Position

The Authorization and Referral Coordinator coordinates, monitors, and facilitates authorization, referral, pre-certification, notification, and related payer requirements for scheduled and unscheduled patient services. The coordinator serves as a liaison among physician offices, providers, clinical departments, Case Management, Utilization Review, Patient Access, insurance companies, and other hospital partners to support timely and accurate financial clearance and minimize barriers to patient care. Under general supervision, the coordinator evaluates payer requirements, establishes workflow and follow-up priorities, coordinates information exchange, monitors outstanding requests, and helps resolve issues that may delay authorization or referral completion. The role ensures information is accurate, documented, communicated to stakeholders, and aligned with payer, regulatory, departmental, and organizational requirements. This is a full-time, non-union, hourly position in Patient Access - Admissions. The listed rate is $27.21 to $34.98 USD. The schedule is a day shift, 8-80, for 80 hours per pay period.

Requirements

High school diploma or equivalent required.
At least one year of experience in healthcare Patient Access, Patient Financial Services, insurance verification, referral coordination, medical office operations, healthcare revenue cycle, customer service, or a related area required.
Strong organization, coordination, prioritization, and time-management skills, including the ability to manage multiple workflows, stakeholders, deadlines, and competing priorities.
Ability to coordinate work across departments and external organizations while maintaining accountability for follow-up, communication, and resolution.
Analytical and problem-solving skills, including the ability to identify barriers, research payer requirements, evaluate options, and coordinate resolutions.
Strong attention to detail and accuracy when reviewing payer requirements, authorization determinations, referral documentation, and patient account information.
Effective verbal and written communication skills, including the ability to explain complex payer requirements and issues to diverse audiences.
Professional interpersonal and customer-service skills when working with patients, providers, physician-office staff, insurers, departments, leadership, and other stakeholders.
Ability to organize and coordinate work independently with minimal supervision and use sound judgment regarding priorities, escalation, and follow-up.
Ability to recognize issues affecting patient access, financial clearance, reimbursement, or scheduled services and take appropriate action.
Ability to facilitate resolution through communication, collaboration, follow-up, and escalation.
Proficiency with personal computers, electronic medical records, payer websites, authorization and referral management systems, insurance verification systems, work queues, reporting tools, and applicable software.
Ability to work collaboratively with departments, providers, physician offices, insurance companies, and external healthcare organizations.
Ability to identify workflow trends and process-improvement opportunities and communicate recommendations to leadership.
Regular, consistent, and punctual attendance at the assigned work location.
Keyboarding proficiency of at least 25 words per minute.
Working knowledge of healthcare terminology, health insurance types, eligibility, benefits, authorization and referral requirements, medical necessity, payer processes, and healthcare revenue-cycle workflows.
Ability to meet deadlines and maintain accuracy in a time-sensitive environment while handling frequent interruptions and changing priorities.
Ability to communicate effectively and professionally through reading, writing, speaking, and telephone communication.
Ability to sit extensively with periodic standing and walking; lift and/or carry up to 20 pounds; and perform the visual and manual tasks necessary for essential job functions.
Occasional off-site travel may be required.

Nice To Haves

Associate degree or higher education, or completion of relevant college coursework.
Relevant healthcare revenue-cycle, patient-access, medical-office, insurance, or authorization/referral certification.
Previous experience coordinating healthcare authorizations, referrals, pre-certifications, or payer requirements.
Previous experience working with health insurance companies, payer portals, electronic medical records, referral-management systems, healthcare revenue-cycle systems, or related applications.
Experience coordinating work across multiple departments, providers, physician offices, or external organizations.

Responsibilities

Coordinate authorization and referral workflows for assigned scheduled and unscheduled services, ensuring requirements are identified, completed, documented, and communicated on time.
Act as a primary coordination point among hospital departments, physician offices, providers, payers, and other stakeholders for authorization, referral, pre-certification, notification, and related payer requirements.
Review scheduled services and patient accounts to identify payer requirements, including authorization, referral, medical necessity, and notification requirements, and determine next steps.
Coordinate with departments and physician offices to assign responsibility for obtaining information and completing payer requirements.
Research payer-specific processes, documentation requirements, and follow-up steps; submit authorization, referral, pre-certification, and notification requests with supporting information.
Review authorization determinations for consistency with planned or rendered services, including procedures, diagnoses, locations, providers, dates, and units.
Coordinate physician referrals and supporting documentation, and ensure referral information is recorded appropriately.
Monitor work queues, reports, task lists, pending requests, and communication channels; prioritize follow-up based on service dates, payer turnaround times, urgency, and departmental criteria.
Follow up with payers on pending, incomplete, or unresolved requests and coordinate responses to requests for additional information or action.
Review authorization and referral information for completeness, accuracy, and consistency; coordinate correction of missing or conflicting information.
Coordinate exchange of clinical documentation and other supporting information among providers, physician offices, Case Management, Utilization Review, clinical departments, and payers.
Communicate status, requirements, outstanding documentation, denials, limitations, and potential barriers to relevant clinical, operational, and physician-office partners.
Identify authorization or referral problems that may affect scheduled services and coordinate options, including potential rescheduling when appropriate and consistent with clinical and departmental processes.
Coordinate inpatient authorization and notification requirements, including payer communication regarding admissions and continued stays.
Provide guidance to Utilization Review, the House Supervisor, physician offices, Patient Access, and others regarding payer-specific inpatient/outpatient requirements and authorization or notification processes.
Review denials and coordinate communications and follow-up within established timelines; facilitate appeals, reconsiderations, peer-to-peer requests, and requests for additional clinical documentation as assigned.
Help departments and stakeholders understand payer requirements, request status, documentation needs, and financial clearance barriers.
Maintain working knowledge of payer requirements, authorization and referral guidelines, medical necessity criteria, insurance contracts, and payer-specific processes.
Maintain effective working relationships with Patient Access, Patient Financial Services, clinical departments, physician offices, Case Management, Utilization Review, and other departments.
Provide professional, respectful, efficient, customer-focused service in person, by telephone, and electronically, using established communication standards and call scripts.
Use applicable electronic medical records, authorization and referral management, insurance verification, communication, document management, and scheduling systems.
Document payer contacts, submission dates, reference numbers, determinations, follow-up activity, outstanding requirements, and other applicable information accurately and promptly.
Identify trends, payer issues, workflow barriers, service-line concerns, and process-improvement opportunities; communicate findings and recommendations to leadership.
Participate in developing and refining workflows, procedures, communication processes, and departmental standards.
Assist with monitoring performance measures, staff training and orientation, reports, audits, process-improvement initiatives, payer-related projects, and other special projects as assigned.
Escalate complex, high-risk, unresolved, or time-sensitive issues to appropriate leadership or subject-matter resources.
Maintain compliance with HIPAA, hospital policies and procedures, and applicable laws and regulations.
Perform other duties as assigned.