Authorization and Referral Specialist (2026-0779)

Valley Medical Center & Clinics; Renton (WA); On-site; USD 30,000 - 44,000; Full time

Job summary

Valley Medical Center is seeking an Authorization and Referral Specialist to support Lifestyle Medicine and Outpatient Rehabilitation. You will handle treatment authorizations, verify benefits, summarize coverage, and schedule referrals to ensure seamless patient care.

The role requires familiarity with ICD-10, CPT, HCPCS, and EMR systems, with Epic experience preferred. Expect standard weekday hours, collaboration across departments, and a focus on accurate, timely processing of referrals.

Qualifications

• Requires High School Diploma or GED.
• Minimum three years of related medical/insurance experience.
• Knowledge of medical terminology and abbreviations.
• Proficiency with Windows and Microsoft apps; basic keyboarding.
• Experience with practice management and EMR systems; Epic preferred.

Responsibilities

• Plan, manage high-volume referrals and prior authorizations.
• Coordinate with Patient Access, Finance, providers and registrars.
• Ensure safe, efficient, patient-centered care and adherence to guidelines.
• Maintain department records and update EMR data.
• Communicate insurance benefits, authorization, and billing to patients.

Skills

Insurance verification

Prior authorization

Communication skills

Time management

Problem solving

Keyboarding/PC skills

Education

High School Diploma or GED

Tools

Epic EMR

Practice management system

Job description

Job Title: Authorization and Referral Specialist

Req: 2026-0779

Location: VMC Main Campus

Department: Outpatient Therapy Services ( 7215 )

Shift

Type: Full Time

FTE: 1

Hours

City State: Renton, WA

Category Professional ( NCNM)

Salary Range: Min $22.04 - Max $31.96/hrly DOE

Job Description

VALLEY MEDICAL CENTER

Job Description

The position description is a guide to the critical duties and essential functions of the job, not an all-inclusive list of responsibilities, qualifications, physical demands, and work environment conditions. Position descriptions are reviewed and revised to meet the changing needs of the organization.

TITLE: Authorization and Referral Specialist

JOB OVERVIEW: The Authorization and Referral Specialist is responsible for supporting the Lifestyle Medicine and Outpatient Rehabilitation service lines by providing treatment authorization, insurance verification, benefit summaries, scheduling, and referral management for all clinical services. Works closely with Patient Financial Services, Admitting Registrars, Providers, Insurance Companies and Patients to ensure a seamless coordination of services.

DEPARTMENT: Lifestyle Medicine and Outpatient Rehabilitation

WORK HOURS: Typically, Monday - Friday, 8:00 am to 5:00 pm or as needed to meet department needs.

REPORTS TO: Lifestyle Medicine/Outpatient Rehabilitation Supervisor, Manager or Director

Prerequisites

• High School Graduate or equivalent (G.E.D.) required.
• Minimum three (3) years of experience in related medical and/or insurance industry required.
• Knowledge of medical terminology and abbreviations required.
• Basic skills in keyboarding and using a personal computer in Windows and Microsoft applications required.
• Prior experience in using practice management and electronic medical record systems required. Epic experience preferred.

Qualifications

• Demonstrated knowledge of clinical ICD-10, CPT, and HCPCS.
• Professional written and verbal communication skills through all mediums.
• Ability to problem solve, exhibiting independent decision-making skills.
• Demonstrated ability to function independently and manage time.
• Demonstrated ability to access, analyze and apply concepts associated with protocol, policy, and guidelines.
• Excellent analytical, critical thinking and attention to detail skills.
• Ability to recognize and understand clinical documentation pertinent for obtaining prior authorizations.
• Demonstrated ability to successfully utilize varying computer tools and software packages:

• Utilize multiple monitors in facilitation of workflow management.
• Healthcare websites/Provider portals.
• Business practice management system.

Unique Physical/Mental Demands, Environment And Working Conditions

Requires legible writing and computer/keyboard skills. Excellent telephone skills are essential. Regular and punctual attendance is a condition of employment. Requires the ability to maintain self-composure and a positive attitude under stress. Requires flexible scheduling and extended hours as needed. Requires problem solving and effective resolution of conflicts. Requires the ability to organize and prioritize work, handling multiple demands simultaneously. Comfortable with continual change and can assimilate new information and use it as needed in daily operations.

Performance Responsibilities

Generic Job Functions: See Generic Job Description for Administrative Partner

Essential Responsibilities And Competencies

Effectively plan, direct, and manage high volume of treatments requiring referral management, scheduling, and prior authorization.

Work as part of an integrated team comprised of Patient Access, Patient Financial Services, providers and admitting registrars.

Collaborate with department leadership, clinical providers, and department staff to ensure safe, efficient, professional, and patient-centered care is provided.

Apply clear understanding of the clinic structure, standards, procedures, and guidelines to ensure consistent and quality delivery of services.

Maintains department specific records as assigned, update and verifies patient data in EMR.

Referral Management and Scheduling

Effectively organize and manage various referral work queues within the electronic medical record.

Coordinate referrals to lifestyle medicine and outpatient rehabilitation services and collaborate with Admitting Registrars on scheduling.

Maintain functional knowledge of patient access and services within the specialized field of Lifestyle Medicine and Outpatient Rehabilitation.

Contact patients using both manual and automated systems to process incoming referrals, register and schedule for appointments.

Insurance Verification and Authorization

Contact insurance companies through portal use and phone contact to obtain benefit verification and prior authorization for treatment; including physical, occupational and speech therapy, cardiac and pulmonary rehab, nutrition and diabetes education and other integrated Lifestyle Medicine Programs.

Organize, pre-authorize, and distribute pre-authorizations in a timely manner to all interested parties.

Routinely review insurance policy updates/change to stay abreast of new ICD-10 and HCPCS pre-authorization requirements.

Communicate with patients regarding insurance benefits, authorization, and billing process.

Coordinate benefits for incoming patients and explore payment options so that our accounts are financially secure.

Clear knowledge of Current Procedural Terminology (CPT), International Classification of Diseases (ICD), and Healthcare Common Procedure Coding System (HCPCS) coding system.

Resolve insurance denials and coordinate with billing to ensure proper coding and documentation is performed.

Informs management team of pre-authorization requirement changes and potential barriers; maintains open line of communication to facilitate additional changes.

Understands and follows formal chain-of-command guidelines in performing job duties.

Projects and/or other duties as assigned.

Created: 1/25

Revised: 3/25

Grade: NC02

FLSA: NE

Cost Center: Multiple

Qualifications

Job Qualifications

• Demonstrated knowledge of clinical ICD-10, CPT, and HCPCS.
• Professional written and verbal communication skills through all mediums.
• Ability to problem solve, exhibiting independent decision-making skills.
• Demonstrated ability to function independently and manage time.
• Demonstrated ability to access, analyze and apply concepts associated with protocol, policy, and guidelines.
• Excellent analytical, critical thinking and attention to detail skills.
• Ability to recognize and understand clinical documentation pertinent for obtaining prior authorizations.
• Demonstrated ability to successfully utilize varying computer tools and software packages:

• Utilize multiple monitors in facilitation of workflow management.
• Healthcare websites/Provider portals.
• Business practice management system.