Oncology Referrals & Authorizations Specialist

memorialhealthcare; United States; On-site; USD 45,000 - 60,000; Full time

Job summary

Memorial Healthcare System seeks a Referrals and Authorizations Coordinator to secure prior authorizations and referrals across inpatient and outpatient services. You will liaise with providers, patients, and insurers to resolve issues, verify eligibility, and ensure timely approvals, supporting accurate reimbursement.

The role requires 2+ years in medical practice with authorization experience, knowledge of payer guidelines, and strong data integrity, communication, and organizational skills.

Qualifications

• High School Diploma or equivalent required.
• Minimum two years' experience in medical practice with authorization experience.
• Knowledge of insurance authorization processes and payer guidelines.

Responsibilities

• Verifies accuracy of referring provider to ensure data integrity.
• Serves as liaison between providers, patients, and insurance companies to resolve authorization and/or referral-related issues.
• Ensures timely follow-up on pending authorizations to prevent treatment delays.
• Collaborates with clinical and scheduling teams regarding authorization status to support treatment planning and scheduling.
• Understands and applies payer-specific guidelines, including Medicare, Medicaid, and commercial insurance requirements for both practice and hospital billing.
• Obtains and documents prior authorizations and referrals for all required services.
• Processes incoming and outgoing referrals from providers, ensuring appropriate documentation and approvals are in place.
• Verifies insurance eligibility and benefits for patients, including coverage for specialty medications and services.

Skills

Accountability

Accuracy & Quality

Customer Service

HIPAA

Insurance Verification

EHR

Effective Communication

Team Work

Data Integrity

Education

High School Diploma or Equivalent

Associate's degree preferred

Tools

EMR Systems

Payer Portals

Healthcare Billing Systems

Job description

Memorial Healthcare System seeks a Referrals and Authorizations Coordinator to secure prior authorizations and referrals across inpatient and outpatient services. You will liaise with providers, patients, and insurers to resolve issues, verify eligibility, and ensure timely approvals, supporting accurate reimbursement.

The role requires 2+ years in medical practice with authorization experience, knowledge of payer guidelines, and strong data integrity, communication, and organizational skills.