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About the Role
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.
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.
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.
Location
- London, KY
Work Type
- Full Time
- Non-Clinical Staff
Education Level
- High school diploma or equivalent
Benefits
- Health, dental, and vision benefits
- Paid time off and paid holidays
- 401k plan
About the Company
- 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.
- At Women’s Care, we believe that our success is built on a foundation of strong, shared values. These values guide our actions, shape our culture, and define who we are as an organization. Communication & Collaboration Transparency Accountability & Integrity Patient Care & Innovation Excellence Respect With the commitment of our employees, we remain true to our mission of providing unparalleled healthcare services to women every day.