Referral and Authorization Coordinator
About The Position
The Referral and Authorization Coordinator is responsible for coordinating referrals and obtaining prior authorizations to ensure patients receive timely access to specialty, diagnostic, therapeutic, and community-based services. This position works collaboratively with providers, clinical staff, patients, insurance companies, and community partners to streamline referral workflows, monitor referral completion, obtain required authorizations, and remove barriers to care. Through effective coordination and communication, this role supports continuity of care, improves patient outcomes, and advances NMHSI's quality initiatives.
Requirements
- Bachelor of Science or Associate's degree in a clinical science or related healthcare field OR a minimum of two (2) years of experience in a related field
- Two (2) or more years of ambulatory care experience
- Experience working with patients managing chronic illnesses
- Experience with data compilation and analysis
- Knowledge of medical terminology
- Experience with quality improvement initiatives
- Strong organizational skills with exceptional attention to detail
- Ability to prioritize multiple tasks and manage competing deadlines
- Intermediate computer proficiency and experience with healthcare technology systems
- Excellent communication, problem-solving, and interpersonal skills
- Ability to work independently while collaborating effectively with multidisciplinary teams
- Current Basic Life Support (BLS)/CPR certification
- Commitment to providing exceptional patient service and supporting access to high-quality healthcare
Nice To Haves
- Experience in a community health or Federally Qualified Health Center (FQHC) setting preferred
Responsibilities
- Coordinate referral activities across all NMHSI locations
- Receive, review, process, and track incoming and outgoing referrals
- Coordinate specialty, diagnostic, imaging, therapy, procedural, and community-based referrals
- Schedule appointments with outside providers when needed
- Communicate referral status and updates with providers, staff, and patients
- Monitor referrals through completion, ensuring consult notes, imaging reports, procedure reports, and specialist recommendations are received and incorporated into the patient's medical record
- Follow up on overdue referrals and unresolved appointments
- Monitor referral completion rates and identify opportunities to improve patient access
- Obtain insurance prior authorizations for diagnostic imaging, procedures, specialty services, therapies, and durable medical equipment (when applicable)
- Submit clinical documentation to support authorization requests
- Track authorization approvals, denials, and expiration dates
- Coordinate peer-to-peer review requests with providers as needed
- Train staff on referral and authorization processes and best practices
- Create and maintain referral databases and tracking tools
- Identify and utilize appropriate community resources to support patients
- Collaborate with providers, clinical teams, insurance companies, and community partners to improve referral workflows and patient outcomes
- Perform other duties as assigned
Benefits
- Medical benefits through BCBS of Michigan or BCN
- Health Savings Account (HSA) with employer contribution
- Employer-sponsored group term life insurance
- Employer-sponsored short-term and long-term disability insurance
- Employee Assistance Program (available immediately)
- Voluntary life insurance options
- 11 paid holidays
- Generous Paid Time Off (PTO)
- 401(k) with Roth option and employer match
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
