Referral Tech - Pre-Authorization MSD - FT - Day

Position Status:

Full time

Shift: First Shift (Days - Less than 12 hours per shift) (United States of America)
Hours per week:40

Job Information Exemption Status:
Non-ExemptA Brief Overview The 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 Qualifications High School Diploma / GED Required Experience Qualifications1 year Registrar/referral and prior authorization experience or 2 years Medical Assistant experience, or equivalent combination of relevant healthcare experience. Required Knowledge of insurance plans, referral workflows, and prior authorization process Preferred Prior experience in imaging, specialty clinics, or hospital-based referrals

Preferred Experience using medical terminology Preferred Working knowledge of ICD 10 and CPT coding Preferred Proficiency with EHR systems and payer portals Preferred

Skills and Abilities

Works 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 Certifications Basic Life Support - BLS Preferred What you will do Obtain prior authorizations for ordered referrals, procedures, and diagnostic services using payer portals, insurance websites, telephone communication, and other payer required methods

Review referrals to ensure required clinical documentation, diagnosis codes, and supporting information are present prior to submission

Interpret basic payer medical necessity criteria and authorization requirements

Track authorization requests and follow up with payers to ensure timely completion

Escalate authorization issues, delays, or denials per departmental workflow

Process outgoing referrals to external facilities, including preparing and faxing required documentation

Ensure referrals are transmitted accurately and documented appropriately in EPIC Manage assigned referral and authorization work queues to meet established turnaround times and productivity standards

Maintain accurate referral status updates within EPIC Respond to internal clinic staff regarding authorization status, insurance requirements, or referral related questions

Communicate delays, denials, or missing information to appropriate clinical or administrative staff

Collaborate with teammates to support consistent workflows and coverage

Utilize EPIC to review orders, clinical documentation, and referral details

Maintain working knowledge of payer rules, authorization trends, and internal referral guidelines

Follow National Patient Safety Goals as applicable, including the use of two patient identifiers

Comply with all organizational, regulatory, and payer requirements

Medical necessity interpretation

Insurance and payer rule adherence

Time management and prioritization

Problem solving and follow-up persistence

Patient-centered communication

Required for All Jobs Complies with all policies, standards, mandatory training and requirements of Stormont Vail Health Performs other duties as assigned

Patient Facing Options Position is Not Patient Facing Remote Work Guidelines Workspace 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 Capability Hybrid Scope No  Supervisory Responsibility No Budget Responsibility No Budget Responsibility Physical Demands Eye/Hand/Foot Coordination:
Continuously greater than 5 hours

Grasping (Fine Motor):
Continuously greater than 5 hours

Hearing:
Continuously greater than 5 hours

Repetitive Motions:
Continuously greater than 5 hours

Sitting:
Continuously greater than 5 hours

Stormont Vail is an equal opportunity…