Authorization & Referral Coordinator

The Philippine Operations Center Global Solutions Inc.; Central Visayas; On-site; PHP 260,000 - 480,000; Full time

Job summary

The Philippine Operations Center Global Solutions Inc. in the Philippines is seeking an Authorization & Referral Coordinator (on-site) to ensure timely and compliant processing of referrals, authorizations, and insurance verifications for patients.

You will review schedules, secure authorizations, verify eligibility, document in the EHR/EMR, and coordinate with clinics and providers. Strong attention to detail and experience in healthcare administration are essential; willingness to work night

Qualifications

• High school diploma or GED required.
• 1 year of experience in referral coordination, insurance verification, or healthcare administration preferred.
• Experience in ophthalmology or surgical scheduling is an advantage.
• Working knowledge of ICD-10 and CPT coding; pre-authorization protocols preferred.

Responsibilities

• Review daily clinic and surgical schedules to identify referral and pre-authorization requirements.
• Prioritize referrals based on clinical urgency and provider availability.
• Secure insurance authorizations for specialist consultations, diagnostics, procedures, and ASC services.
• Coordinate and process pre-surgical authorizations in accordance with payer guidelines.
• Verify patient insurance eligibility and benefits before scheduled appointments.
• Document insurance information in the EHR/EMR system.
• Resolve discrepancies by coordinating with patients, insurers, and internal teams.
• Collaborate with clinics, providers, and call centers regarding status.
• Track co-payments, benefits, and coverage limits.
• Maintain logs of authorizations and communications.
• Manage digital records through scanning, uploading, and faxing documents to the EHR.

Skills

Attention to detail

Organizational skills

Communication skills

Insurance verification

Authorization

Medical billing

Google Workspace

ICD-10 CPT

Night shifts

On-site

Education

High school diploma or GED

Tools

Google Workspace

EHR/EMR System

Job description

Authorization & Referral Coordinator (ON-SITE)

Job Overview
We are seeking a detail-oriented and highly organized Authorization & Referral Coordinator to support the seamless delivery of healthcare services. This role is responsible for managing insurance eligibility, patient referrals, and pre-authorizations to ensure timely and compliant processing.

The ideal candidate will play a critical role in enhancing patient experience, expediting access to care, and supporting efficient reimbursement and cash flow operations.

Key Responsibilities:

Referral & Authorization Management

• Review daily clinic and surgical schedules to identify referral and pre-authorization requirements
• Prioritize referrals based on clinical urgency and provider availability
• Secure insurance authorizations for specialist consultations, diagnostics, procedures, and ASC services
• Coordinate and process pre-surgical authorizations in accordance with payer guidelines

Insurance Verification & Documentation

• Verify patient insurance eligibility and benefits prior to scheduled appointments
• Accurately document insurance information in the EHR/EMR system
• Resolve discrepancies by coordinating with patients, insurance providers, and internal teams

Interdepartmental Communication & Compliance

• Collaborate with clinics, providers, and call centers regarding referral and authorization status
• Ensure adherence to federal, state, and payer-specific guidelines
• Track co-payments, benefits, and coverage limits, particularly for recurring or specialty services

Record Maintenance & Digital Management

• Maintain accurate logs of authorizations and insurance communications
• Manage digital records through scanning, uploading, and faxing documents to the EHR
• Monitor pending referrals/authorizations and follow up to ensure timely completion

Knowledge Management

• Stay updated on payer requirements, workflows, and insurance policy changes
• Serve as a resource for internal teams on referral and authorization processes

Qualifications:

Required Skills & Competencies

• Strong attention to detail and organizational skills
• Excellent written and verbal communication skills with a professional and empathetic approach
• Ability to manage multiple priorities in a fast-paced environment
• Knowledge of insurance verification, prior authorization, and medical billing processes
• Proficiency in Google Workspace and ability to navigate multiple systems
• Familiarity with ICD-10, CPT codes, and billing modifiers
• Flexible and dependable; willing to work night shifts and on-site

Education & Experience:

• High school diploma or GED required
• Must be at least 1 year of experience in referral coordination, insurance verification, or healthcare administration
• Experience in ophthalmology or surgical scheduling is an advantage
• Working knowledge of ICD-10 and CPT coding standards and pre-authorization protocols (highly preferred)