Authorization & Referrals Coordinator
Memorial Healthcare System
Summary
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.
Job description
Summary
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.
Responsibilities
- Ensures timely follow-up on pending authorizations to prevent treatment delays.
- Collaborates with clinical and scheduling teams regarding authorization status to support treatment planning and scheduling.
- Understands and applies payer-specific guidelines, including Medicare, Medicaid, and commercial insurance requirements for both practice and hospital billing.
- Obtains and documents prior authorizations and referrals for all required services.
- Processes incoming and outgoing referrals from providers, ensuring appropriate documentation and approvals are in place.
- Verifies insurance eligibility and benefits for patients, including coverage for specialty medications and services.
- Verifies accuracy of referring provider to ensure data integrity and accuracy.
- Serves as liaison between providers, patients, and insurance companies to resolve authorization and/or referral-related issues.
Complexity of Work
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.
Requirements
- High School Diploma or Equivalent
- Minimum of two (2) years' experience in medical practice
- Knowledge of medical terminology
- Knowledge of insurance authorization processes
- Familiarity with payer portals, EMR systems, and healthcare billing systems
- Strong interpersonal and communication skills
- Attention to detail
- Ability to manage multiple tasks in a fast-paced environment
Benefits
- Veteran's Preference
Company overview
Memorial Healthcare System is one of the largest not-for-profit healthcare systems in the United States, headquartered in Hollywood, Florida. Founded in 1953, the organization operates six major hospitals including Memorial Regional Hospital, Memorial Hospital West, Memorial Hospital Miramar, Memorial Hospital Pembroke, and the renowned Joe DiMaggio Children's Hospital. With approximately 17,000 employees, Memorial Healthcare System provides a comprehensive continuum of care ranging from primary care services to advanced tertiary and quaternary programs such as adult and pediatric cardiac transplant, bone marrow transplant, trauma care, and intensive care services. The system has earned numerous prestigious awards including recognition as a Florida Cancer Center of Excellence, U.S. News and World Report Best Hospitals for Rehabilitation, and Great Place to Work certification. Memorial Healthcare System is committed to delivering patient-centered care through innovative medical services including cancer care, cardiac and vascular services, neuroscience, orthopedics, pediatrics, and women's health services, while maintaining a strong focus on community outreach and medical education programs.