Referral and Authorization Coordinator- Infusion Service

UnityPoint Health; Springfield (IL); Remote; USD 45,000 - 65,000; Full time

Benefits offered by this job

Paid time off

Parental leave

401K matching

Dental and health insurance

Daily Pay

Tuition reimbursement

Adoption assistance

Pet insurance

Job summary

UnityPoint Health is seeking a Referral and Authorization Coordinator - Infusion Services to manage new referrals, coordinate authorizations, and ensure timely access to infusion therapies across our ambulatory infusion enterprise.

You will enter referral data into the EMR, evaluate medical necessity, collaborate with providers and payers, and support appeals, financial assistance resources, and patient cost-share guidance to minimize treatment delays and improve the patient experience.

Qualifications

• High School Diploma or GED required.
• 2 years experience with benefit investigations, formulary reviews, and prior authorization workflows.
• 2 years infusion services, specialty pharmacy, or high-cost medication workflows preferred.
• EMR and payer portal experience preferred.
• 1 year medical experience, preferably in community health, home health or pharmacy, required.

Responsibilities

• Manage infusion service referrals, including intake, scheduling, medication coordination, and timely communication with patients and referring providers.
• Conduct insurance eligibility and benefit investigations, including formulary reviews and cost-share assessments.
• Submit and monitor prior authorizations, obtain clinical documentation, and follow up with payers for timely approvals.
• Review authorization denials, coordinate appeals, and suggest alternative therapies when needed.
• Coordinate with medication assistance advocates to connect patients with financial resources to reduce barriers.
• Maintain relationships with patients, providers, referral sources, pharmacies, and internal teams; direct inquiries appropriately.
• Provide excellent customer service, maintain accurate documentation, and support process improvements.

Education

High School Diploma/GED

Pharmacy technician certification or registration (Iowa, Illinois, Wisconsin)

Job description

Overview

Referral and Authorization Coordinator - Infusion Services

Schedule: Monday-Friday, 8:30 a.m.-5:00 p.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.

Why UnityPoint Health?

At UnityPoint Health, you matter. We're proud to be recognized as a Top 150 Place to Work in Healthcare by Becker's Healthcare several years in a row for our commitment to our team members.Our competitive Total Rewards program offers benefits options that align with your needs and priorities, no matter what life stage you're in. Here are just a few:

• Expect paid time off, parental leave, 401K matching and an employee recognition program.
• Dental and health insurance, paid holidays, short and long-term disability and more. We even offer pet insurance for your four-legged family members.
• Early access to earned wages with Daily Pay, tuition reimbursement to help further your career and adoption assistance to help you grow your family.

With a collective goal to champion a culture of belonging where everyone feels valued and respected, we honor the ways people are unique and embrace what brings us together.And, we believe equipping you with support and development opportunities is a vital part of delivering an exceptional employment experience.Find a fulfilling career and make a difference with UnityPoint Health.

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.
• Review authorization denials, coordinate appeals, and collaborate with providers to identify appropriate alternative therapies when necessary.
• 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

Education:High School Diploma/GED High school graduate or equivalent. Required

Licenses and Certifications

• Preferred: Pharmacy technician certification or registration in the state(s) of practice, as applicable (Iowa, Illinois, and/or Wisconsin).
• Time Frame: Upon hire, if applicable.

Work Experience Requirements: 2 years Experience with benefit investigations, formulary reviews, and prior authorization workflows. Preferred2 years Experience in infusion services, specialty pharmacy, or high-cost medication workflows. Preferred2 years Experience using electronic medical records (EMRs) and payer portals. Preferred1 year Medical experience, preferably in community health, home health, or pharmacy. Required