Job Overview

We are seeking an organized Bilingual Prior Authorization & PCP Referral Coordinator to join our healthcare operations team in a full-time remote role. You will manage daily prior authorization requests and Primary Care Physician (PCP) referrals to ensure patients receive timely medical care without treatment delays. Key responsibilities include monitoring superbills, verifying CPT/ICD-10 codes, navigating insurance portals, and documenting reference numbers accurately in the EMR. Strong bilingual communication skills, U.S. health insurance knowledge, and high attention to detail are required.

Schedule: Mon-Fri, flexible during EST business hours (40 hrs per week)

Responsibilities

Prior Authorization Management

• Monitor uploaded superbills throughout the day to identify services requiring prior authorization.
• Review all designated CPT codes that require insurance authorization.
• Submit prior authorization requests through insurance portals or contact insurance companies by phone when necessary.
• Utilize the provided diagnosis codes and supporting clinical documentation to complete authorization requests.
• Process authorization requests promptly as they are received to prevent backlogs.
• Prioritize same-day authorizations for services performed on the current day whenever possible.
• Accurately document authorization numbers, approval dates, insurance reference numbers, and related information within the patient's electronic medical record (EMR).
• Follow up on pending authorizations to ensure timely approvals and minimize delays in patient care.

PCP Referral Coordination

• Verify whether patients with HMO insurance plans require Primary Care Physician (PCP) referrals prior to their appointments.
• Contact patients and/or PCP offices to obtain required referrals before scheduled appointments whenever possible.
• Follow up on outstanding referral requests throughout the day until resolved.
• Record referral numbers, expiration dates, and all relevant information accurately within the patient's EMR.
• Coordinate with providers, front office staff, and insurance representatives to resolve referral-related issues efficiently.

Documentation & Communication

• Maintain accurate, complete, and up-to-date documentation within the EMR.
• Immediately communicate authorization delays, insurance issues, or referral concerns to management.
• Ensure all assigned authorizations and referrals are completed by the end of each business day whenever possible.
• Maintain confidentiality and compliance with HIPAA and organizational policies.

Must-Have Requirements

• Previous experience in Prior Authorization, Medical Insurance Verification, Referral Coordination, Medical Billing, or a similar healthcare administrative role.
• Strong understanding of U.S. health insurance plans, including HMO, PPO, Medicare, and Medicaid.
• Experience working with CPT, ICD-10, and diagnosis codes.
• Familiarity with electronic medical records (EMR/EHR) systems.
• Spanish-speaking proficiency is required.
• Excellent verbal and written English communication skills.
• Strong organizational, multitasking, and time-management abilities.
• High attention to detail and accuracy.
• Ability to work independently while managing multiple priorities throughout the day.
• Experience working in specialty medical practices is preferred.
• Familiarity with insurance portals and payer authorization systems, is preferred.
• Knowledge of medical terminology and healthcare workflows, is preferred.

Independent Contractor Perks

Permanent work from home

Immediate hiring

Health Insurance Coverage for eligible locations

Note

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.

One application, multiple possibilities: When you apply, our team reviews your background against all current openings, not just this one! If a different role fits your skills, we'll get in touch! We also encourage you to keep exploring our job board and apply directly to any position that excites you.