Referral Tech - Pre-Authorization MSD - FT - Day

Stormont-Vail HealthCare, Inc.; Topeka (KS); Hybrid; USD 40,000 - 52,000; Full time

Job summary

Stormont Vail Health is seeking a Referral Technician to manage referrals and obtain prior authorizations for primary care and specialty services across the organization. You will coordinate with providers, insurance carriers, and external facilities to verify benefits, submit and track requests, and ensure timely access to care within EPIC.

Role requires strong attention to detail, teamwork, and proficiency with EPIC and payer portals.

Qualifications

• Requires High School Diploma or GED.
• Minimum 1 year registrar/referral and prior authorization experience or 2 years Medical Assistant experience.
• Knowledge of insurance plans, referral workflows, and prior authorization processes.
• Prior experience in imaging, specialty clinics, or hospital-based referrals preferred.

Responsibilities

• Obtain prior authorizations for referrals, procedures, and diagnostic services using payer portals and other payer required methods.
• Review referrals for required documentation and coding before submission.
• Track authorization requests and follow up with payers to ensure timely completion.
• Escalate issues, delays, or denials per workflow and maintain EPIC referral records.

Skills

Team-based collaboration

Attention to detail

Problem solving

Time management

HIPAA compliance

EPIC proficiency

Payer portal knowledge

Education

High School Diploma / GED

Tools

EPIC

Payer portals

Insurance systems

Job description

Position Status:Full timeShift:First Shift (Days - Less than 12 hours per shift) (United States of America)Hours per week:40Job InformationExemption Status: Non-ExemptA Brief OverviewThe Referral Technician is responsible for managing patient referrals and obtaining prior authorizations for primary care and specialty services ordered across the organization to ensure timely and accurate access to care. This role coordinates with providers, insurance carriers, and external facilities to verify benefits, confirm medical necessity, submit and track authorization requests, and ensure accurate transmission of referrals. The Referral Technician works extensively within EPIC, payer portals, and insurance systems to support compliant referral processing and documentation. Limited scheduling support may be provided for select departments; however, scheduling is not a primary function of this role.Education QualificationsHigh School Diploma / GED RequiredExperience Qualifications1 year Registrar/referral and prior authorization experience or 2 years Medical Assistant experience, or equivalent combination of relevant healthcare experience. RequiredKnowledge of insurance plans, referral workflows, and prior authorization process PreferredPrior experience in imaging, specialty clinics, or hospital-based referrals PreferredExperience using medical terminology PreferredWorking knowledge of ICD 10 and CPT coding PreferredProficiency with EHR systems and payer portals PreferredSkills and AbilitiesWorks effectively within a team based, high-volume environment (Required proficiency)Demonstrates strong attention to detail and accuracy (Required proficiency)Uses critical thinking and problem-solving skills to resolve authorization barriers (Required proficiency)Manages time efficiently and meets turnaround expectations in assigned work queues (Required proficiency)Maintains patient confidentiality and adheres to HIPAA regulations (Required proficiency)Demonstrates advanced proficiency in EPIC, including referral and authorization workflows (Required proficiency)Licenses and CertificationsBasic Life Support - BLS PreferredWhat you will doObtain prior authorizations for ordered referrals, procedures, and diagnostic services using payer portals, insurance websites, telephone communication, and other payer required methodsReview referrals to ensure required clinical documentation, diagnosis codes, and supporting information are present prior to submissionInterpret basic payer medical necessity criteria and authorization requirementsTrack authorization requests and follow up with payers to ensure timely completionEscalate authorization issues, delays, or denials per departmental workflowProcess outgoing referrals to external facilities, including preparing and faxing required documentationEnsure referrals are transmitted accurately and documented appropriately in EPICManage assigned referral and authorization work queues to meet established turnaround times and productivity standardsMaintain accurate referral status updates within EPICRespond to internal clinic staff regarding authorization status, insurance requirements, or referral related questionsCommunicate delays, denials, or missing information to appropriate clinical or administrative staffCollaborate with teammates to support consistent workflows and coverageUtilize EPIC to review orders, clinical documentation, and referral detailsMaintain working knowledge of payer rules, authorization trends, and internal referral guidelinesFollow National Patient Safety Goals as applicable, including the use of two patient identifiersComply with all organizational, regulatory, and payer requirementsMedical necessity interpretationInsurance and payer rule adherenceTime management and prioritizationProblem solving and follow-up persistencePatient-centered communicationRequired for All JobsComplies with all policies, standards, mandatory training and requirements of Stormont Vail HealthPerforms other duties as assignedPatient Facing OptionsPosition is Not Patient FacingRemote Work GuidelinesWorkspace is a quiet and distraction-free allowing the ability to comply with all security and privacy standards.Stable access to electricity and a minimum of 25mb upload and internet speed.Dedicate full attention to the job duties and communication with others during working hours.Adhere to break and attendance schedules agreed upon with supervisor.Abide by Stormont Vail’s Remote Worker Policy and will review and acknowledge the Remote Work Agreement annually.Remote Work CapabilityHybridScopeNo Supervisory ResponsibilityNo Budget Responsibility No Budget ResponsibilityPhysical DemandsEye/Hand/Foot Coordination: Continuously greater than 5 hoursGrasping (Fine Motor): Continuously greater than 5 hoursHearing: Continuously greater than 5 hoursRepetitive Motions: Continuously greater than 5 hoursSitting: Continuously greater than 5 hoursStormont Vail is an equal opportunity employer and adheres to the philosophy and practice of providing equal opportunities for all employees and prospective employees, without regard to the following classifications: race, color, ethnicity, sex, sexual orientation, gender identity and expression, religion, national origin, citizenship, age, marital status, uniformed service, disability or genetic information. This applies to all aspects of employment practices including hiring, firing, pay, benefits, promotions, lateral movements, job training, and any other terms or conditions of employment.Retaliation is prohibited against any person who files a claim of discrimination, participates in a discrimination investigation, or otherwise opposes an unlawful employment act based upon the above classifications.