A large managed care organization is seeking a detail-oriented Referral Coordinator to process and track referrals/authorizations, coordinate with providers, and ensure members receive timely access to care. This role blends member support, provider outreach, and accurate documentation within established turnaround times.
Create, process, and track provider referrals and prior authorizations; verify eligibility/benefits.
Review clinical documentation for completeness; route cases per established guidelines.
Communicate with providers, facilities, and members to obtain missing information and close loops.
Monitor referral status and turnaround times; escalate aging cases and barriers to care.
Document all activities accurately in EMR/authorization platforms; maintain HIPAA compliance.
Answer inbound calls and manage work queues; meet daily productivity and quality metrics.
Collaborate with Utilization Management, Care Management, and Provider Relations on complex cases.
Generate basic reports (e.g., open referrals, denials, expirations) and support audits.
1–2+ years in a health plan, provider office, or hospital setting handling referrals/authorizations.
Working knowledge of medical terminology, CPT/HCPCS and ICD-10, payer rules, and TAT standards.
Proficiency with EMR/authorization portals and Microsoft Outlook/Excel/Teams.
Strong communication, follow-up, and customer service skills; high attention to detail.
Ability to protect PHI and follow HIPAA and organizational policies.
Must be able to work on-site in Manchester, NH Tuesday–Thursday and reliably work remote Monday & Friday.
Experience in managed care/utilization management.
Familiarity with NH provider networks and regional health systems.
Bilingual skills a plus.
Standard business hours, with occasional flexibility for operational needs.
Quiet home workspace for remote days; reliable high-speed internet.
Background check and I-9 employment eligibility required.
Competitive hourly pay and eligibility for employer benefits package