Hybrid Referral & Authorization Specialist

Wayne State University Physician Group; United States; Hybrid; USD 38,000 - 60,000; Full time

Job summary

Wayne Health is seeking a Referral and Authorization Coordinator to support care delivery and revenue in Detroit, MI. Hybrid schedule with regular in-office attendance is required.

The role focuses on obtaining pre-certifications, coordinating referrals, scheduling outpatient testing, and maintaining clear communication with patients and providers. Strong knowledge of ICD10/CPT and EMR systems is essential.

Qualifications

• High School Diploma or equivalent.
• Minimum 2-3 years insurance, medical prior authorization, billing or Physician Office experience.
• Proficiency in ICD10 and CPT codes.
• Experience navigating EMR systems (NextGen or Athena preferred).
• Strong verbal and written communication skills.

Responsibilities

• Process referrals and submit medical records to insurance carriers for prior authorization.
• Verify patient’s insurance eligibility, benefits and requirements with carriers.
• Schedule imaging and diagnostic appointments.
• Schedule appointments for new and returning patients.
• Request, track and obtain pre-authorizations from insurers.
• Document communications in the EMR and maintain accurate records.
• Prioritize authorizations by urgency to the patient.
• Provide excellent customer service and resolve patient inquiries.

Skills

ICD10/CPT

Outlook

Excel

Teams

EMR navigation

Communication

Customer service

Typing 35 wpm

Education

High School Diploma

Medical insurance experience

Tools

NextGen

Athena

Job description

Wayne Health is seeking a Referral and Authorization Coordinator to support care delivery and revenue in Detroit, MI. Hybrid schedule with regular in-office attendance is required.

The role focuses on obtaining pre-certifications, coordinating referrals, scheduling outpatient testing, and maintaining clear communication with patients and providers. Strong knowledge of ICD10/CPT and EMR systems is essential.