Referral & Authorization Representative – Outpatient Scheduling

About the role

The Referral & Authorization Representative is responsible for financially clearing outpatient referrals, verifying insurance, obtaining authorizations, and ensuring timely scheduling of visits.

Key responsibilities

• Process referrals in the provider EMR, verify insurance eligibility and benefits, and obtain necessary authorizations.
• Contact patients to discuss coverage, advise on payment requirements, and document all communications.
• Maintain statistical information on payers and communicate denials to the Outpatient Scheduling Manager.
• Meet productivity standards by processing referrals within three business days and initiating authorizations within the same timeframe.
• Provide guidance to department staff and assist with training of new scheduling representatives.

Required profile

• High school graduate/GED (or 2‑5 years healthcare experience in lieu of education).
• At least six months of progressive work experience, preferably in hospital outpatient referrals or insurance verification.
• Ability to communicate effectively, manage multiple priorities, and maintain attention to detail.
• Basic knowledge of computer hardware and software applications.