Referrals & Authorizations Coordinator - FT - Days - MHW

Memorial Healthcare

1d•Onsite

About The Position

The Referrals and Authorizations Coordinator secures prior authorizations and primary care referrals for both professional and hospital technical services across inpatient and outpatient care, including surgeries, procedures, and specialist visits. This role facilitates timely access to care, minimizes treatment delays, and supports accurate reimbursement through payer compliance.

Requirements

High School Diploma or Equivalent (Required)
Knowledge of medical terminology, and insurance authorization processes.
Familiarity with payer portals, EMR systems, and healthcare billing systems.
Strong interpersonal and communication skills with attention to detail.
Ability to manage multiple tasks in a fast-paced environment.
A minimum of two (2) years’ experience in medical practice, preferably in a setting with authorization experience.

Nice To Haves

Associate’s degree preferred.

Responsibilities

Serves as liaison between providers, patients, and insurance companies to resolve authorization and/or referral-related issues.
Verifies accuracy of referring provider to ensure data integrity and accuracy.
Verifies insurance eligibility and benefits for patients, including coverage for specialty medications and services.
Processes incoming and outgoing referrals from providers, ensuring appropriate documentation and approvals are in place.
Obtains and documents prior authorizations and referrals for all required services.
Understands and applies payer-specific guidelines, including Medicare, Medicaid, and commercial insurance requirements for both practice and hospital billing.
Collaborates with clinical and scheduling teams regarding authorization status to support treatment planning and scheduling.
Ensures timely follow-up on pending authorizations to prevent treatment delays.