Authorization & Referral Coordinator

Authorization & Referral Coordinator

The Authorization and Referral Coordinator is responsible for coordinating, monitoring, and facilitating authorization, referral, pre-certification, notification, and related payer requirements necessary for scheduled and unscheduled patient services. Serves as a central resource and liaison between physician offices, providers, clinical departments, Case Management, Utilization Review, Patient Access, insurance companies, and other hospital partners to promote timely and accurate financial clearance and minimize barriers to patient care.

Under general supervision, the coordinator evaluates authorization and referral requirements, establishes appropriate workflow and follow-up priorities, coordinates the exchange of required information, monitors outstanding requests, and facilitates resolution of issues that may delay or prevent authorization or referral completion. The position ensures authorization and referral information is accurate, appropriately documented, communicated to affected stakeholders, and aligned with payer, regulatory, departmental, and organizational requirements.

The Authorization and Referral Coordinator Serves as a central resource and liaison for internal and external customers, including physician offices, providers, clinical departments, Case Management, Utilization Review, Patient Access, insurance companies, and other hospital partners, to promote timely and accurate financial clearance and minimize barriers to patient care.

EXPECTATION FOR ALL EMPLOYEES

Supports the organization’s mission, vision, and values by adhering to the behavioral standards of Bay Area Hospital. Comply with all applicable laws, regulations, and organizational policies affecting Bay Area Hospital. Maintains familiarity with and adherence to the Code of Conduct and supports the Bay Area Hospital Compliance Program. Demonstrates effective communication skills and the ability to work collaboratively and professionally with individuals from diverse backgrounds.

POSITION SUMMARY

The Authorization and Referral Coordinator is responsible for coordinating, monitoring, and facilitating authorization, referral, pre-certification, notification, and related payer requirements necessary for scheduled and unscheduled patient services. Serves as a central resource and liaison between physician offices, providers, clinical departments, Case Management, Utilization Review, Patient Access, insurance companies, and other hospital partners to promote timely and accurate financial clearance and minimize barriers to patient care.

Under general supervision, the coordinator evaluates authorization and referral requirements, establishes appropriate workflow and follow-up priorities, coordinates the exchange of required information, monitors outstanding requests, and facilitates resolution of issues that may delay or prevent authorization or referral completion. The position ensures authorization and referral information is accurate, appropriately documented, communicated to affected stakeholders, and aligned with payer, regulatory, departmental, and organizational requirements.

The Authorization and Referral Coordinator Serves as a central resource and liaison for internal and external customers, including physician offices, providers, clinical departments, Case Management, Utilization Review, Patient Access, insurance companies, and other hospital partners, to promote timely and accurate financial clearance and minimize barriers to patient care.

PRINCIPAL DUTIES AND RESPONSIBILITIES

• Coordinates the overall authorization and referral workflow for assigned services, including scheduled and unscheduled services, ensuring requirements are identified, addressed, documented, and communicated within established timelines.
• Serves as a primary coordination point between hospital departments, physician offices, providers, payers, and other stakeholders regarding authorization, referral, pre-certification, notification, and related payer requirements.
• Reviews scheduled services and patient accounts to identify authorization, referral, pre-certification, notification, medical necessity, and other payer requirements and determines appropriate next steps.
• Coordinates with appropriate departments and physician offices to establish responsibility for obtaining required information and completing outstanding payer requirements.
• Reviews payer requirements and determines the appropriate payer-specific process, documentation, and follow-up needed to support authorization or referral completion.
• Coordinates submission of authorization, referral, pre-certification, and notification requests to insurance carriers and other payers, ensuring required documentation and supporting information are available and appropriately submitted.
• Reviews authorization determinations to ensure approved services, procedures, diagnoses, locations, providers, date ranges, units, and other applicable information correspond to the planned or rendered services.
• Coordinates the collection and completion of required physician referrals and supporting documentation and ensures referral information is appropriately recorded.
• Monitors assigned authorization and referral work queues, reports, task lists, pending requests, and other departmental workflows to prioritize outstanding items, identify barriers, and ensure timely progression and resolution.
• Establishes follow-up priorities based on scheduled service dates, payer turnaround times, clinical urgency, and other applicable departmental criteria.
• Follows up with insurance companies and other payers regarding pending, incomplete, or unresolved requests and coordinates next steps when additional information or action is required.
• Reviews authorization and referral information for completeness, accuracy, and consistency; identifies missing or conflicting information and coordinates appropriate correction or follow-up.
• Coordinates the exchange of clinical documentation and other suppor