Referral / Authorization Coordinator

This is a fully remote position, open to applicants in Texas.

📋 Description

• Review and process incoming referral requests and prior authorization submissions swiftly and accurately, adhering to payer guidelines.

• Confirm insurance coverage and benefits through online portals and phone communications to verify eligibility, in-network providers, and authorization needs.

• Collaborate with providers and clinic personnel to gather essential clinical notes, orders, and supporting documents necessary for approvals.

• Apply medical terminology, CPT codes, and ICD-9/ICD-10 coding to ensure accurate and comprehensive referral and authorization submissions.

• Adhere strictly to HIPAA and organizational privacy regulations when managing patient information during the referral process.

• Track, monitor, and record all referral and authorization activities within the electronic health record (EHR) and other tracking systems to guarantee audit readiness.

• Follow up with insurance companies to verify status, appeal denials when necessary, and clarify any missing or inaccurate information.

• Effectively communicate with providers, clinic staff, and patients regarding referral status, necessary steps, and any issues that may impact scheduling or approval.

• Collaborate closely with billing and front-office teams to minimize denied claims by ensuring accurate documentation of authorization information prior to services.

⛳️ Requirements

• In-depth knowledge of managed care policies, insurance verification processes, and general medical office practices.

• Preferred experience in a medical office, clinic, hospital, or dental office managing referrals, authorizations, medical records, or billing.

• Proficient in CPT and ICD-9/ICD-10 coding concepts, with the ability to interpret clinical information related to authorization requirements.

• Understanding of HIPAA regulations with a strong commitment to maintaining the confidentiality and privacy of patient information at all times.

• Competence in navigating electronic health record (EHR) systems efficiently, ensuring accurate and comprehensive documentation of all activities.

• Solid grasp of medical terminology across primary care and specialty services; experience in a dental office is a plus.

• Outstanding written and verbal communication abilities for effective liaison with providers, insurance companies, and patients.

• High attention to detail, strong organizational skills, and the capacity to manage multiple referrals and insurance requests concurrently.

• Comfortable working independently in a remote setting, meeting productivity and turnaround time expectations.

🏝️ Benefits

• Competitive hourly wage based on experience, with regular performance evaluations and opportunities for salary increases.

• Fully remote position offering stable, full-time hours and a predictable schedule.

• Comprehensive training on our systems, referral workflows, and insurance requirements, accompanied by ongoing support from seasoned team members.

• Opportunity for advancement into senior referral, authorization, or revenue cycle roles as you enhance your skills and performance.

• Paid time off, paid holidays, and access to company benefits in accordance with organizational policies (detailed information provided during the hiring process).

• A supportive, collaborative work environment that emphasizes accuracy, communication, and respect for every patient.

• Opportunity to make a meaningful impact by aiding patients in obtaining timely approvals and accessing the care they require while working from home.