United States onlyThis is a remote position.
We are hiring an experiencedPre-Authorization & Referral Coordinatorto support a fast-pacedU.S.-based medical office.This role is responsible for insurance verification, prior authorizations, and referral coordination while ensuring compliance with U.S. insurance guidelines. The ideal candidate has direct experience working within the U.S. healthcare system handling Medicare, Medicaid, and commercial insurance plans.
This is a full-time remote position supporting a medical practice located in the United States. The role is offered as anIndependent Contractoropportunity.
Key Responsibilities
- Verify active insurance coverage and review detailed benefits
- Determine patient financial responsibility (copays, deductibles, coinsurance, out-of-pocket maximums)
- Obtain and manage prior authorizations for procedures, imaging, and specialty services
- Submit and track authorization requests through payer portals (Availity, UHC, Aetna, Cigna, etc.)
- Review and attach required clinical documentation
- Process and track internal and external referrals
- Ensure compliance with HMO referral requirements
- Enter and document authorization details in EMR/EHR systems
- Follow up on pending authorizations and assist with resolving denials
- Communicate insurance requirements and authorization status clearly to patients
