Outpatient Referral & Authorization Representative

About the role

The Outpatient Referral & Authorization Representative ensures that all outpatient referrals are financially cleared before patients receive care. This includes processing referrals in the provider EMR, verifying insurance eligibility, obtaining authorizations, and communicating with patients and providers.

Key responsibilities

• Process outpatient referrals in the EMR, verify insurance eligibility, and obtain necessary authorizations within three business days.
• Contact patients to discuss coverage, payment requirements, and arrange payments when insurance does not cover 100% of the service.
• Maintain statistical information on payers and report regularly to the Outpatient Scheduling Center Supervisor.
• Document all communications and authorizations in the referral system and EMR.
• Assist and train other scheduling representatives, perform QA audits, and support process‑improvement initiatives.

Required profile

• High school diploma or GED; 2‑5 years of healthcare experience may substitute for education.
• At least six months of progressive work experience in a related role.
• Ability to manage multiple priorities, maintain attention to detail, and communicate effectively.

Required skills

• Proficiency with EMR systems and general computer hardware/software applications.
• Knowledge of medical terminology, coding rules, and insurance verification processes.