Referral Coordinator

Emory•Atlanta, GA

34d

About The Position

Be inspired. Be valued. Belong . At Emory Healthcare At Emory Healthcare we fuel your professional journey with better benefits, valuable resources, ongoing mentorship and leadership programs for all types of jobs, and a supportive environment that enables you to reach new heights in your career and be what you want to be . We provide: Comprehensive health benefits that start day 1 Student Loan Repayment Assistance & Reimbursement Programs Family-focused benefits Wellness incentives Ongoing mentorship, development, leadership programs And more Description The Referral and Authorization Coordinator is responsible for coordinating all aspects of the outpatient and inpatient referral and preauthorization process. This role ensures accurate and timely completion of referral requests, insurance verification, and medical necessity reviews while maintaining compliance with payer requirements and organizational policies. The coordinator works closely with patients, providers, insurance carriers, and clinical staff to ensure appropriate authorization for services, procedures, and appointments. This position supports patient access to care by facilitating communication, resolving authorization issues, and maintaining accurate documentation in the electronic health record and related systems.

Requirements

High school diploma or equivalent required.
One (1) year of experience in a medical-related field, physician billing, coding, or collections required OR One-year certification in a related healthcare field and six (6) months of relevant experience.

Responsibilities

Referral and Authorization Management Coordinate all aspects of outpatient and inpatient referral and preauthorization processes.
Review referrals for medical necessity and verify insurance eligibility and benefits coverage.
Process referrals according to established guidelines and procedures, including appropriate use of ICD-9 diagnosis codes and procedure codes.
Obtain authorization or precertification from insurance carriers as required.
Patient and Provider Coordination Coordinate emergency and non-emergency appointments, procedures, or surgeries with patients, physicians, and healthcare facilities prior to service.
Contact patients to confirm referral appointments and provide information regarding authorization status.
Answer patient inquiries related to referrals, authorizations, and billing questions.
Communicate with providers and facilities regarding referral requirements and authorization status.
Documentation and Data Management Enter patient and referral information into designated systems according to departmental procedures.
Verify data for accuracy and completeness.
Maintain organized preauthorization files and documentation to support compliance and audit readiness.
Issue Resolution and Process Support Identify, track, and resolve issues related to the authorization and referral process.
Review and process insurance and provider correspondence related to referrals and authorizations.
Assist in improving workflow efficiency by identifying recurring issues and working with leadership to address them.
Professional Development and Additional Responsibilities Work with management to develop professional growth plans.
Participate in educational training and in-service programs as appropriate.
Perform other duties as assigned to support departmental operations.