Prior Authorization & Referrals Specialist

Phoenix Heart; Glendale (AZ); On-site; USD 42,000 - 62,000; Full time

Job summary

Phoenix Heart is seeking an Authorization Coordinator to manage prior authorizations for diagnostic tests, verify insurance eligibility and benefits, and ensure required referrals are in place before patient visits.

The role requires meticulous attention to detail, strong communication skills, and the ability to work with physicians, health plans, and patients. Experience with medical accreditation and EMR systems is preferred. This is a fast-paced, in-office position in a clinical setting.

Qualifications

• 2+ years of related experience and/or training.
• In-depth knowledge and understanding of medical health insurance.
• Working knowledge of cardiology preferred, but not required.
• Diagnostic authorization testing experience.
• Ability to handle stressful situations with professionalism and provide excellent customer service.
• Strong problem-solving, prioritization and multi-tasking abilities.
• Ability to work with minimal supervision and outside core hours when needed.
• Excellent communication, both written and verbal, with all levels of staff and patients.

Responsibilities

• Review appointment schedule for the current date through five days out, and manage add-on authorizations/referrals daily.
• Verify patient eligibility and benefits.
• Contact referring physicians, PCPs or health plans for referrals and authorizations.
• Contact patients for insurance verification when needed.
• Handle inbound/outbound calls regarding referrals/authorizations.
• Update patient accounts with relevant information.
• Add referrals/authorization details to service dates before claims are filed.
• Assist billing with eligibility and authorization questions.
• Review EMR, email, fax, and interoffice communications; respond within 24 hours.
• Inform manager of any difficulties obtaining authorizations/referrals from carriers or physician offices.
• Notify changes by carriers/physician offices in authorizations/referrals.
• Participate in referral/authorization education for clinic staff.
• Notify Front Office if authorization or referrals are missing before patient visits.
• Before leaving, review add-on schedule for the next day.
• Scan referrals/authorizations into patient charts; document thoroughly.
• Participate in new hire/annual training as required.
• Other tasks as assigned.

Skills

Medical insurance knowledge

Diagnostic authorization experience

Interpersonal communication

Multitasking

Problem solving

Attention to detail

Education

High school diploma or equivalent

Tools

PC software proficiency

EMR systems

Job description

Phoenix Heart is seeking an Authorization Coordinator to manage prior authorizations for diagnostic tests, verify insurance eligibility and benefits, and ensure required referrals are in place before patient visits.

The role requires meticulous attention to detail, strong communication skills, and the ability to work with physicians, health plans, and patients. Experience with medical accreditation and EMR systems is preferred. This is a fast-paced, in-office position in a clinical setting.