Referral Tech - Pre-Authorization MSD - FT - Day

Stormont Vail Health•Topeka, KS

1d•Hybrid

About The Position

The Referral Technician is responsible for managing patient referrals and obtaining prior authorizations for primary care and specialty services ordered across the organization to ensure timely and accurate access to care. This role coordinates with providers, insurance carriers, and external facilities to verify benefits, confirm medical necessity, submit and track authorization requests, and ensure accurate transmission of referrals. The Referral Technician works extensively within EPIC, payer portals, and insurance systems to support compliant referral processing and documentation. Limited scheduling support may be provided for select departments; however, scheduling is not a primary function of this role.

Requirements

High School Diploma / GED Required
1 year Registrar/referral and prior authorization experience or 2 years Medical Assistant experience, or equivalent combination of relevant healthcare experience. Required
Works effectively within a team based, high-volume environment (Required proficiency)
Demonstrates strong attention to detail and accuracy (Required proficiency)
Uses critical thinking and problem-solving skills to resolve authorization barriers (Required proficiency)
Manages time efficiently and meets turnaround expectations in assigned work queues (Required proficiency)
Maintains patient confidentiality and adheres to HIPAA regulations (Required proficiency)
Demonstrates advanced proficiency in EPIC, including referral and authorization workflows (Required proficiency)

Nice To Haves

Knowledge of insurance plans, referral workflows, and prior authorization process Preferred
Prior experience in imaging, specialty clinics, or hospital-based referrals Preferred
Experience using medical terminology Preferred
Working knowledge of ICD 10 and CPT coding Preferred
Proficiency with EHR systems and payer portals Preferred
Basic Life Support - BLS Preferred

Responsibilities

Obtain prior authorizations for ordered referrals, procedures, and diagnostic services using payer portals, insurance websites, telephone communication, and other payer required methods
Review referrals to ensure required clinical documentation, diagnosis codes, and supporting information are present prior to submission
Interpret basic payer medical necessity criteria and authorization requirements
Track authorization requests and follow up with payers to ensure timely completion
Escalate authorization issues, delays, or denials per departmental workflow
Process outgoing referrals to external facilities, including preparing and faxing required documentation
Ensure referrals are transmitted accurately and documented appropriately in EPIC
Manage assigned referral and authorization work queues to meet established turnaround times and productivity standards
Maintain accurate referral status updates within EPIC
Respond to internal clinic staff regarding authorization status, insurance requirements, or referral related questions
Communicate delays, denials, or missing information to appropriate clinical or administrative staff
Collaborate with teammates to support consistent workflows and coverage
Utilize EPIC to review orders, clinical documentation, and referral details
Maintain working knowledge of payer rules, authorization trends, and internal referral guidelines
Follow National Patient Safety Goals as applicable, including the use of two patient identifiers
Comply with all organizational, regulatory, and payer requirements
Medical necessity interpretation
Insurance and payer rule adherence
Time management and prioritization
Problem solving and follow-up persistence
Patient-centered communication
Complies with all policies, standards, mandatory training and requirements of Stormont Vail Health
Performs other duties as assigned