Referral Tech - Pre-Authorization MSD - FT - Day

Position Status:

Shift:

Hours per week:

Job Information
Exemption Status: Non-Exempt

A 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 Qualifications

• 1 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
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• 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 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.