Referral Coordinator

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• And more

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.

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.

MINIMUM QUALIFICATIONS

Education

• High school diploma or equivalent required.

Experience

• 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.

PHYSICAL REQUIREMENTS (MediumMax 25lbs): up to 25 lbs 0-33% of the work day (occasionally); 11-25 lbs 34-66% of the workday (frequently); 01-10 lbs 67-100% of the workday (constantly); Lifting 25 lbs max; Carrying of objects up to 25 lbs; Occasional to frequent standing & walking Occasional sitting Close eye work (computers typing reading writing) Physical demands may vary depending on assigned work area and work tasks.

ENVIRONMENTAL FACTORS: Factors affecting environment conditions may vary depending on the assigned work area and tasks. Environmental exposures include but are not limited to: Blood-borne pathogen exposure Bio-hazardous waste Chemicals/gases/fumes/vapors Communicable diseases Electrical shock Floor Surfaces Hot/Cold Temperatures Indoor/Outdoor conditions Latex Lighting Patient care/handling injuries Radiation Shift work Travel may be required. Use of personal protective equipment including respirators environmental conditions may vary depending on assigned work area and work tasks.

Emory is an equal opportunity employer and qualified applicants will receive consideration for employment without regard to race color religion sex national origin disability protected veteran status or other characteristics protected by state or federal law.

Emory Healthcare is committed to providing reasonable accommodations to qualified individuals with disabilities upon request. Please contact Emory Healthcares Human Resources at . Please note that one weeks advance notice is preferred.