Referrals & Authorization Clerk (74550)

Women's Care•London, KY

3d•Onsite

About The Position

London Women's Care is dedicated to delivering high-quality, comprehensive healthcare for every member of your family. From newborns to seniors, our skilled providers offer a wide range of specialties, including Primary Care, OBGYN, Pediatrics, Dentistry, and Behavioral Health. The Referrals & Authorization Clerk is responsible for coordinating patient referrals, obtaining insurance authorizations, and ensuring timely and accurate communication between providers, patients, and external healthcare facilities. This position plays a critical role in maintaining continuity of care and supporting efficient clinic operations.

Requirements

High school diploma or equivalent required.
Experience working with healthcare referrals, scheduling, or insurance verifications strongly preferred.
Knowledge of medical terminology strongly preferred.
Strong organizational and time management skills.
Attention to detail and accuracy in documentation.
Effective communication with patients, providers, and external facilities.
Ability to manage multiple tasks in a fast-paced environment.
Familiarity with EMR systems (preferably Veradigm) and insurance processes.
Must be dependable, reliable, and punctual.

Responsibilities

Process outgoing referrals in a timely manner.
Verify completeness of referral orders (diagnosis, provider, documentation).
Schedule appointments with specialists, imaging centers, or ancillary services.
Ensure referrals meet payer requirements and guidelines.
Obtain prior authorizations for procedures, imaging, and specialty visits.
Verify patient insurance eligibility and benefits related to referrals.
Communicate authorization approvals, denials, or additional requirements.
Track authorization status and follow up as needed.
Contact patients to provide referral details, appointment instructions, and required documents.
Educate patients on referral processes and insurance requirements.
Address patient questions regarding referrals and authorizations.
Coordinate with referring providers, specialists, hospitals, and diagnostic facilities.
Send necessary documentation (clinical notes, labs, imaging reports).
Maintain professional relationships with external offices.
Accurately document all referral activity in the EMR (Veradigm workflows).
Maintain tracking logs for referrals and authorizations.
Ensure all referral-related documentation is scanned and attached appropriately.
Monitor referral work queues and resolve outstanding items.
Ensure referrals comply with payer requirements and regulatory standards.
Maintain confidentiality in accordance with HIPAA guidelines.
Assist with audits or quality reviews related to referral processes.
Demonstrate and embody the Women’s Care mission and core values.
Other duties as assigned.