Job Overview

We are seeking a highly detailed Referral and Authorization Coordinator to manage insurance approvals for patient visits, procedures, and surgeries. In this remote role, you will act as a vital liaison between patients, healthcare providers, and insurance companies to secure timely prior authorizations and pre-certifications. Your core focus will be maintaining accurate documentation in the EMR, navigating various insurance portals, and proactively minimizing authorization-related claim denials. This part-time independent contractor position requires a strong background in medical administrative workflows and payer requirements.

 

Job Highlights

Schedule: Mon-Fri, 8 am - 5 pm EST

Work Arrangement: Work from home

Contract: Independent Contractor

 

Responsibilities

• All referrals and authorizations completed prior to patient appointments and procedures.
• Maintain accurate and timely documentation of authorization activity.
• Minimize authorization-related appointment delays and cancellations.
• Reduce authorization-related claim denials through proactive verification and follow-up.
• Ensure timely turnaround of authorization requests according to payer requirements.
• Maintain a high level of patient satisfaction through effective communication and coordination.

Referral Management

• Obtain and verify referrals required for new and established patient office visits.
• Monitor referral expiration dates, visit limits, and authorization requirements.
• Communicate with referring providers to obtain necessary documentation and referral information.
• Ensure referrals are entered accurately into the EMR and linked to patient appointments.
• Follow up on missing referrals to prevent appointment delays or cancellations.

Authorization Management

• Submit and obtain prior authorizations and pre-certifications for:
• Office visits
• In-office procedures
• Surgical procedures
• Durable Medical Equipment (DME)
• Outpatient and facility-based procedures
• Review clinical documentation for completeness prior to submission.
• Track authorization requests through completion and document status updates in the EMR.
• Obtain authorization extensions, modifications, or additional visits when required.
• Coordinate peer-to-peer reviews and appeal processes when necessary.

Scheduling & Coordination

• Verify all referrals and authorizations are completed prior to patient appointments and procedures.
• Coordinate with providers, surgery schedulers, hospitals, and outside facilities to ensure authorization requirements are met.
• Communicate authorization approvals, denials, and pending statuses to patients and clinical staff.
• Maintain authorization logs and work queues to ensure timely follow-up.

Insurance Verification & Compliance

• Verify patient insurance eligibility and benefits related to scheduled services.
• Maintain current knowledge of payer-specific authorization guidelines and requirements.
• Ensure compliance with Medicare, Medicaid, commercial insurance, and managed care plans.
• Accurately document all authorization numbers, approval dates, service dates, and payer communications.

Denial Prevention & Resolution

• Identify authorization-related issues before services are rendered.
• Investigate and resolve authorization denials.
• Assist with appeals and resubmissions when appropriate.
• Work collaboratively with billing staff to reduce authorization-related claim denials and reimbursement delays.

 

Requirements

• High school diploma or equivalent required; medical office experience preferred.
• Minimum of 5 years of experience in medical referrals, authorizations, scheduling, or insurance verification.
• Knowledge of medical terminology, CPT codes, ICD-10 diagnosis coding, and payer authorization processes preferred.
• Experience with EMR systems and insurance portals.
• Strong organizational skills and attention to detail.
• Ability to manage multiple priorities and meet deadlines in a fast-paced environment.
• Excellent communication and customer service skills.

 

Independent Contractor Perks

HMO Coverage for eligible locations

Permanent work from home

Immediate hiring

Steady freelance job

 

Side Note

This is a permanent work-from-home role under an Independent Contractor arrangement. Candidates must have their own computer and reliable internet connection, and are responsible for their own taxes and benefits. Professional hourly fees are established based on your performance in the application process.

Please click the "Apply" button to complete your application, including the assessment questions, technical check, and voice recording. Your hourly pay rate will be established based on your performance in the application process; submissions with all requirements fulfilled will receive priority review.