Referral & Authorization Coordinator

Wayne State University Physician Group (UPG)

. Obtain pre-certifications and pre-authorizations for procedures and specialist referral appointments .

Posted 10/6/2026full-timeRemote • Michigan • United StatesJuniorMid-LevelWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in medical prior authorization processes, including ICD10 and CPT coding, while effectively managing patient communications and insurance verification. Proficient in utilizing EHR systems and Microsoft Office tools to enhance operational efficiency and maintain high-quality service standards.

Highest-signal resume keywords

Medical Prior Authorization ExperienceICD10 And CPT Code KnowledgeEHR Navigation ProficiencyCustomer Service SkillsInsurance Verification Expertise

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

ICD10 CodingCPT CodingMedical BillingInsurance VerificationData EntryReferral CoordinationDocumentation AccuracyProductivity Metrics AchievementMedical TerminologyOffice Skills

Soft Skills

Verbal CommunicationWritten CommunicationProblem-SolvingInterpersonal SkillsAttention To Detail

Tools & Technologies

Microsoft OutlookMicrosoft TeamsMicrosoft WordMicrosoft ExcelEHR SystemsNextgenAthena

Industry Keywords

Medical OfficePatient ReferralsPrior AuthorizationsInsurance CoverageHealth And Safety Compliance

About the role

Key responsibilities & impact

Obtain pre-certifications and pre-authorizations for procedures and specialist referral appointments
Schedule outpatient testing with other providers for Wayne Health
Coordinate, document and process medical referrals and prior authorizations requested by clinic providers
Answer incoming calls from patients and the public
Schedule appointments for imaging, diagnostic services, and new and returning patients
Make follow-up phone calls and address complaints
Troubleshoot problems and provide information to patients and the public
Process referrals and submit medical records to insurance carriers
Verify patient insurance eligibility and benefits
Request, track, follow up on and secure authorizations before services
Manage referral repositories including EHR buckets, provider email, faxes, Auth inbox and Teams message groups
Document and communicate patient correspondence and messages in the EMR
Apply ICD10 and CPT code knowledge
Achieve productivity and quality metrics
Review authorization information for accuracy and completeness
Prioritize authorizations by patient urgency
Update patient insurance, contact details and demographics in the EHR
Monitor insurance changes affecting coverage and authorization requirements
Support appeals for denied authorizations
Update patient information and registration
Respond to patient inquiries by phone and email
Research information using available resources
Resolve and escalate patient complaints and urgent or emergent questions
Route calls to appropriate resources
Follow up with patients and callers within departmental timeframes
Document communications according to standard operating procedures
Answer Wayne Health calls and contribute to team operations

Requirements

What you’ll need

High School Diploma or equivalent required
Minimum 2-3 years insurance, medical prior authorization, billing or Physician Office experience
Working knowledge of ICD10 and CPT Codes
Able to operate and stay organized when using multiple computer screens and website windows
Proficiency in Microsoft Outlook, Teams, Word and Excel
Intermediate medical terminology
Basic office skills including typing 35 wpm and accurately enter alpha numeric data
Possess excellent verbal, written communication and problem-solving skills
Excellent interpersonal skills necessary to establish and maintain productive working relationships with physicians, patients and their families and other people both inside and outside the clinical practice area
Excellent customer service skills including the ability to use independent thinking, sound judgement and creativity when resolving customer issues or concerns
Attention to detail in documentation and communication
Ability to effectively work independently and with a team
Manage multiple tasks with shifting priorities
Knowledge of medical insurance and medical office billing
Proficient in navigating EHR, Nextgen or Athena system preferred
Ability to stand/sit for long periods of times and lift up to 50 pounds
Requires sensitivity to work with seriously ill patients and their families
Compliance with Department Health and Safety policies and procedures

Benefits

Comp & perks

Full-time, 40 hour work week
Additional hours may be required
EEO/AA/Veteran/Disability Employer