Referral and Authorization Coordinator- Infusion Service

UnityPoint Health; Madison (WI); Remote; USD 52,000 - 76,000; Full time

Benefits offered by this job

Dental insurance

Health insurance

Paid holidays

Short-term disability

Long-term disability

Daily Pay

tuition reimbursement

Adoption assistance

Job summary

UnityPoint Health is seeking a skilled Referral and Authorization Coordinator for Infusion Services. This role manages referrals, coordinates prior authorizations, and ensures compliant access to infusion therapies across ambulatory sites.

You will enter data into the EMR, evaluate medical necessity, and collaborate with providers and payers to prevent delays. The coordinator conducts benefit investigations, submits authorizations and appeals, and partners with billing and medication assistance

Qualifications

• High School Diploma or GED.
• Pharmacy technician certification/registration in IA, IL, or WI.
• Minimum 2 years in benefit investigations, formulary reviews, and prior authorizations.
• Experience with EMRs and payer portals preferred.
• Medical experience in community health, home health, or pharmacy preferred.

Responsibilities

• Manage infusion service referrals with intake, scheduling, and communication with patients and referring providers.
• Conduct insurance eligibility and benefit investigations, formulary reviews, network requirements, and cost-share assessments.
• Submit and monitor prior authorizations, gather clinical documentation, and liaise with payers for timely approvals.
• Coordinate with medication assistance advocates to connect patients with manufacturer programs and financial resources.
• Maintain relationships with patients, providers, referrers, pharmacies, and internal teams; direct inquiries appropriately.

Skills

Customer service

Communication

Attention to detail

Education

High School Diploma/GED

Pharmacy technician certification/registration

Tools

EMR systems

Payer portals

Job description

Referral and Authorization Coordinator - Infusion Services

Schedule: Monday-Friday, 8:30 a.m.-Remote/work from home with strong preference for candidates residing within the UPH geographies of Iowa, Illinois, & Wisconsin.

The Referral and Authorization Coordinator - Infusion Services is responsible for managing new referrals and coordinating authorization processes to ensure timely, accurate, and compliant access to infusion therapies across UnityPoint Health's ambulatory infusion enterprise. This role enters and maintains referral information in the electronic medical record (EMR), evaluates medical necessity, coordinates prior authorizations, and collaborates with providers and payers to prevent treatment delays for high-cost, complex infusion medications.

Key responsibilities include conducting benefit investigations, submitting authorization requests and appeals, and partnering with billing, revenue cycle teams, and medication assistance advocates to coordinate appeals, identify financial assistance resources, and provide cost-share guidance. This position helps patients navigate the financial aspects of their infusion therapy while maintaining accurate documentation, ensuring compliance with payer requirements, and following established workflows and policies.

The Referral and Authorization Coordinator also collaborates with internal teams and external partners to resolve authorization and referral challenges, support process improvements, and enhance operational efficiency. Through effective coordination and communication, this role helps promote timely patient access to care and a positive patient experience.

Dental and health insurance, paid holidays, short and long-term disability and more. Early access to earned wages with Daily Pay, tuition reimbursement to help further your career and adoption assistance to help you grow your family. And, we believe equipping you with support and development opportunities is a vital part of delivering an exceptional employment experience.

Key Responsibilities

• Manage infusion service referrals, including accurate intake, scheduling, medication coordination, and timely communication with patients and referring providers.
• Conduct insurance eligibility and benefit investigations, including formulary reviews, coverage restrictions, network requirements, and patient cost-share assessments.
• Submit and monitor prior authorizations, obtain required clinical documentation, and follow up with payers to support timely approval of infusion therapies.
• Coordinate with medication assistance advocates to connect patients with manufacturer assistance programs, foundations, and other financial resources to reduce barriers to treatment.
• Maintain positive relationships with patients, providers, referral sources, pharmacies, and internal teams while directing inquiries to the appropriate service line.
• Provide excellent customer service, maintain accurate documentation, meet productivity and performance expectations, and support process improvements and other operational needs as assigned.

Qualifications

High School Diploma/GED High school graduate or equivalent. Pharmacy technician certification or registration in the state(s) of practice, as applicable (Iowa, Illinois, and/or Wisconsin).

Work Experience Requirements: 2 years Experience with benefit investigations, formulary reviews, and prior authorization workflows. Preferred 2 years Experience using electronic medical records (EMRs) and payer portals. Preferred 1 year Medical experience, preferably in community health, home health, or pharmacy.