Referral & Surgical Authorization Coordinator

Job Summary

We are seeking a detail-oriented and highly organized Referral & Surgical Authorization Coordinator to manage all incoming and outgoing referrals, as well as surgical insurance authorizations within our orthopedic practice.

This role is responsible for ensuring patients move efficiently from referral intake through surgical approval, while maintaining compliance with insurance requirements and minimizing delays in care. The ideal candidate demonstrates strong follow-through, excellent communication skills, and the ability to manage multiple cases in a fast-paced surgical environment.

Key ResponsibilitiesReferral Management

• Process all incoming referrals from primary care providers and specialists
• Review referral documentation for completeness and accuracy
• Verify referral validity, authorization requirements, and payor guidelines
• Contact referring offices for missing documentation when necessary
• Enter referral information accurately into Athena EMR

Surgical Authorization Management

• Initiate, submit, and track all surgical authorization requests
• Ensure CPT and ICD-10 codes submitted for authorization align with provider documentation
• Confirm that required clinical documentation (notes, imaging reports, conservative care history) is complete prior to submission
• Monitor authorization status daily to prevent surgical delays
• Coordinate peer-to-peer review scheduling when required
• Communicate approval, denial, or pending status to surgical scheduler and provider
• Maintain organized tracking logs for all pending and approved surgical cases
• Work closely with billing staff to address authorization-related denials

Insurance & Eligibility Verification

• Verify patient eligibility and benefits prior to consultation and surgery
• Identify payor-specific authorization requirements
• Communicate patient financial responsibility when applicable

Outgoing Referrals

• Process outgoing referrals for imaging, physical therapy, DME, or specialty services
• Confirm network participation to prevent patient leakage
• Track completion of referred services and ensure reports are returned to the practice

Communication & Follow-Up

• Serve as liaison between referring providers, patients, surgical facilities, and insurance carriers
• Maintain accurate documentation of all communications in Athena EMR
• Proactively follow up on pending authorizations to prevent delays in care

Qualifications

• Minimum 2 years of experience in medical referrals and surgical authorizations
• Strong knowledge of orthopedic CPT coding and authorization processes
• Experience with Athena EMR preferred
• Familiarity with commercial insurance, Medicare, and Workers’ Compensation processes
• Excellent organizational and case-management skills
• Strong verbal and written communication skills

Performance Expectations

• Minimal surgery cancellations due to authorization delays
• Timely submission of all surgical authorization requests
• Accurate documentation within Athena EMR
• Low denial rate related to authorization errors

Pay: $23.00 - $28.00 per hour

Work Location: Remote