Patient Authorizations and Referrals Specialist II

Job Description Summary

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Manages prior authorization and referral workflows, applying working knowledge of payer requirements
and clinical systems to ensure timely approvals, accurate documentation, and smooth care transitions.
Patient Authorizations and Referrals Specialist II handles standard operational processes under
moderate supervision, applying working knowledge to tasks that occasionally require interpretation or
deviation from standard procedures. Decisions are procedure-driven and have direct impact on team
output. This job communicates information that may require explanation, and achieves results within
defined oversight.

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How will you make an impact & Requirements

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KEY RESPONSIBILITIES

• Process and track prior authorizations and referral requests from intake through resolution, verifying payer requirements, clinical documentation, and coverage for compliance.
• Manage moderately non-routine situations — including complex authorizations, urgent requests, and appeals — applying judgment within established payer and organizational guidelines.
• Communicate directly with patients, providers, and payers to obtain missing information, relay authorization decisions, and resolve routine discrepancies.
• Maintain accurate authorization and referral records in the EHR and authorization management platforms, ensuring data integrity and timely status updates.
• Identify recurring processing challenges and communicate patterns to supervisors to support workflow improvements.
• Provide guidance to entry-level specialists on standard authorization and referral procedures.

QUALIFICATIONS

• High school diploma required; associate degree preferred.
• 1–3 years of prior authorization, referral coordination, or managed care experience.
• Working knowledge of insurance products, payer authorization requirements, and EHR systems.
• Ability to manage multiple open cases simultaneously with accuracy under moderate supervision.
• Strong written and verbal communication skills for patient, provider, and payer interactions.
• Experience with authorization management platforms preferred.

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Compensation Range:

$19.00

to

$28.50

The anticipated base salary range represents the Company's good-faith estimate of the compensation it reasonably expects to pay for this position at the time of posting. Actual compensation will be determined based on factors including experience, skills, qualifications, geographic location, internal equity, and business needs.

Originally posted on Himalayas