| Location | White Plains, NY |
| Salary | $35,000–$36,000 Per Year |
Referral & Authorization Representative | Westchester Community Health Center
Westchester Community Health Center
formerly Mount Vernon Neighborhood Health Center
formerly Mount Vernon
Neighborhood Health Center
formerly Mount Vernon Neighborhood Health Center
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Referral & Authorization Representative
Posted on: August 12, 2026
Under the supervision of the Patient Financial Services/Business Office Supervisor, the Referral & Authorization Representative is responsible for performing insurance verification and eligibility checks and ensuring that all required pre-authorizations and referrals for specialty services are obtained in a timely manner. Ensures that authorizations and referrals required by managed care and commercial insurance plans are documented accurately in patient accounts prior to scheduled appointments. Notifies the supervisor and documents appropriate notes in the patient account when authorizations or referrals are denied by the insurance company.
Essential Duties:
Print and review patient schedules 1-3 days prior to the date of service (DOS) to identify and verify required insurance authorizations and referrals.
Obtain and process required authorizations and referrals for patients scheduled for specialty services across all organizational locations.
Complete data entry, print claims, and submit pre-determinations for dental services across all service locations.
Void pre-determination charges once the applicable ADA forms have been printed and mailed.
Compile and maintain a list of approved and denied dental service requests; obtain necessary approvals and scan/email documentation to the Dental Director.
Mail patient statements for applicable patient responsibility amounts as outlined in insurance approval letters for dental pre-determination services.
When the patient's PCP is not affiliated with MVNHC, YHC, or GHC, contact the patient or referring physician's office to obtain the required authorization number or referral.
Verify authorizations and referrals obtained from outside PCPs by telephone or through the insurance company's website to ensure all information matches the scheduled appointment and requested services.
For same-day appointments, contact insurance companies as needed to obtain or confirm required authorizations and referrals.
Accurately document insurance-related updates in patient accounts, including terminated coverage, denied or pending authorizations/referrals, and non-covered services.
Enter all medical and dental authorizations and referrals into the 'Referrals In' module and patient accounts, and scan supporting documentation into the appropriate records.
Notify the supervisor of any authorizations or referrals that are pending, denied, or unable to be obtained prior to the scheduled appointment.
Perform related clerical and administrative duties to support the effective operation of the assigned area.
Provide coverage and assistance to other areas within the department as needed.
Perform additional duties and responsibilities as assigned or requested.
Qualifications:
Working knowledge and experience with data entry and computer-based systems.
Six months to one year of experience in healthcare, medical billing, insurance, or a related field preferred.
Previous experience providing customer or client service, preferably in a healthcare setting.
Strong verbal and written communication skills, including professional telephone etiquette.
Basic mathematical skills with strong attention to detail and accuracy.
Strong organizational and administrative skills, with the ability to manage paperwork and maintain accurate records.
Ability to prioritize and manage multiple tasks effectively in a fast-paced environment.
Ability to make timely decisions and exercise sound judgment when addressing routine issues.
Previous experience working directly with patients or the public.
High school diploma or General Educational Development (GED) certificate required.
EOE/M/F/Vet/Disabled
Job Type: Full-time
Pay: $35,000 - $36,000 annually
Benefits:
Dental Insurance
Health Insurance
Life Insurance
Paid Time Off
Vision Insurance
Schedule: Monday to Friday
Benefit Conditions: A waiting period may apply
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Westchester Community Health Center offers high-quality primary, preventative, and affordable health care and support services in an atmosphere of humane care, dignity and respect to improve the health and lives of adults, teens, and children in Westchester County and the Bronx, New York. We are a 501(c)(3) non-profit organization.
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Westchester Community Health Center
107 West Fourth Street
Mount Vernon, NY 10550
phone: (914) 699-7200
email: info@wchchealth.org
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Our health center is a Health Center Program grantee under 42 USC 254b and a deemed Public Health Service employee under 42 USC 233(g)-(n). We are an FTCA-Deemed Facility, accredited by the Joint Commission and recognized by the National Committee for Quality Assurance (NCQA). We receive Federal Health and Human Services (HHS) funding and have Federal Public Health Service (PHS) deemed status with respect to certain health related claims, including medical malpractice claims, for itself and its covered individuals.
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