Authorization & Referral Coordinator – w/ Athenahealth Experience (Onsite)

The Philippine Operations Center Global Solutions Inc.; Central Visayas; On-site; PHP 240,000 - 420,000; Full time

Job summary

The Philippine Operations Center Global Solutions Inc. in Cebu City is seeking an Authorization & Referral Coordinator with hands-on Athenahealth experience to support referrals and prior authorizations for our healthcare account.

Responsibilities include verifying patient insurance, managing referrals, and coordinating with providers and payers to ensure timely authorizations while maintaining accurate records in the EHR/EMR. This is a 100% onsite role in Cebu City.

Qualifications

• Minimum high school diploma required.
• At least 1 year of experience in referral coordination or healthcare administration.
• Hands-on experience using Athenahealth is required.
• Experience in medical records management is an advantage.
• Knowledge of U.S. healthcare insurance processes.

Responsibilities

• Review daily clinic and surgical schedules to identify referral requirements.
• Process patient referrals to specialists and facilities.
• Secure insurance authorizations for visits, diagnostics, procedures, and ASC services.
• Coordinate pre-surgical authorizations per payer requirements.
• Monitor pending referrals and authorization requests with timely follow-ups.
• Verify patient insurance eligibility and document in the EHR/EMR.
• Maintain compliance with regulations and confidentiality.

Skills

Athenahealth experience

US healthcare processes

Organization & attention to detail

Strong communication

Multitasking

Education

High school diploma or equivalent

Tools

Athenahealth (Athena)

Job description

Authorization & Referral Coordinator – Athenahealth Experience Required (On-site)

Job Description

We are looking for a detail-oriented and experienced Authorization & Referral Coordinator to join our healthcare account.

As an Authorization & Referral Coordinator, you will be responsible for managing patient referrals, insurance verification, and prior authorization processes to support the timely delivery of healthcare services. You will coordinate with insurance providers, healthcare professionals, and internal teams to ensure that referral and authorization requirements are properly processed, documented, and followed up.

The ideal candidate has hands-on experience using Athenahealth (Athena), a good understanding of U.S. healthcare insurance processes, and strong organizational and communication skills. Experience in medical records management is also an advantage.

This is a 100% onsite position in Cebu City.

Key Responsibilities:

Referral and Authorization Management

• Review daily clinic and surgical schedules to identify referral and pre-authorization requirements.

• Process patient referrals to specialists, diagnostic facilities, and other healthcare providers.

• Secure insurance authorizations for specialist visits, diagnostic services, procedures, and ambulatory surgical center (ASC) services.

• Coordinate and process pre-surgical authorizations in accordance with payer requirements and established protocols.

• Monitor pending referrals and authorization requests, ensuring timely submission, follow-ups, and resolution.

Insurance Verification & Documentation

• Verify patient insurance eligibility, benefits, and coverage requirements before scheduled appointments and procedures.

• Ensure accurate and complete documentation of patient insurance information in the electronic health record (EHR/EMR).

• Identify and resolve discrepancies or incomplete insurance information by coordinating with patients, insurance providers, and internal teams.

• Review co-payments, insurance benefits, coverage limitations, and other payer-specific requirements.

Interdepartmental Communication & Compliance

• Collaborate with clinics, healthcare providers, and internal teams regarding delays or issues related to referrals and authorizations.

• Coordinate with insurance providers to clarify coverage requirements and resolve authorization concerns.

• Escalate pending, denied, or incomplete authorization requests when necessary.

• Maintain clear and professional communication with relevant stakeholders to facilitate timely patient care.

Record Maintenance & Digital Management

• Maintain detailed records of referrals, authorization requests, approvals, and insurance communications.

• Scan, upload, organize, and/or fax supporting documents to the appropriate electronic health record system.

• Monitor outstanding referrals and authorizations and conduct necessary follow-ups.

• Ensure compliance with applicable healthcare regulations, patient confidentiality requirements, and payer-specific guidelines.

Knowledge Management

• Stay current on payer requirements, referral workflows, and insurance policy updates as directed by the department lead.

• Act as a resource to internal departments by providing clarification on referral/authorization processes.

About You

• High school diploma or equivalent.

• At least 1 year of experience in referral coordination, insurance verification, or healthcare administration.

• Hands-on experience using Athenahealth (Athena) is required.

• Previous experience in medical records management is a strong advantage.

• Experience in ophthalmology, specialty clinics, or surgical scheduling is highly desirable.

• Knowledge of U.S. healthcare insurance processes, including eligibility verification and prior authorization procedures.

• Familiarity with medical terminology, ICD-10, CPT codes, and billing modifiers.

• Strong verbal and written communication skills.

• Excellent attention to detail and organizational skills.

• Ability to multitask, manage competing priorities, and navigate multiple systems simultaneously.

• Strong problem-solving skills and ability to work independently and effectively as part of a team.

• Adaptable to changes in processes, systems, and client requirements.

• Willingness and ability to work 100% onsite in Cebu City.