Prior Authorization & Referral Coordinator

A&C Medical Center is a growing multi-specialty medical practice dedicated to providing high-quality patient care. We are seeking a detail-oriented and organized Prior Authorization & Referral Coordinator to help ensure patients receive timely access to medical services, procedures, imaging, medications, and specialty care. Position Summary The Prior Authorization & Referral Coordinator is responsible for obtaining insurance authorizations, processing referrals, verifying benefits, and coordinating care between providers, insurance companies, and patients. The ideal candidate has experience working with PPO, HMO, workers' compensation, and personal injury cases and understands the importance of accurate documentation and timely follow-up. Responsibilities Submit and track prior authorization requests for procedures, surgeries, imaging, medications, therapy, and specialty services. Obtain and process referrals for specialist consultations and ancillary services. Verify insurance eligibility, benefits, authorization requirements, and referral requirements. Follow up with insurance carriers regarding authorization status, denials, and appeals. Coordinate with providers and clinical staff to obtain necessary medical documentation. Communicate authorization and referral updates to patients and referring providers. Maintain accurate records in the electronic medical record (EMR) system. Monitor authorization expiration dates and obtain extensions when necessary. Assist with workers' compensation and personal injury authorization requests when applicable. Prepare and submit appeal letters for denied services. Ensure compliance with insurance guidelines, HIPAA regulations, and clinic policies. Perform other administrative duties as assigned.

Qualifications Required:

Minimum 1 year of experience in medical prior authorizations, referrals, medical billing, or insurance verification. Knowledge of PPO, HMO, Medicare, and commercial insurance plans. Strong understanding of medical terminology and healthcare workflows. Excellent organizational skills and attention to detail. Strong written and verbal communication skills. Ability to manage multiple tasks and meet deadlines. Proficient with EMR/EHR systems and Microsoft Office.

Preferred:

Experience with urgent care, orthopedic, surgical, or multi-specialty practices. Knowledge of workers' compensation and personal injury cases. Bilingual English/Spanish or English/Chinese is a plus.

Skills Insurance Verification Prior Authorizations Referral Management Medical Records Review Appeals and Denials Management Patient Communication Time Management Multitasking EMR/EHR Systems Pay:

$18.00 - $22.00 per hour

Work Location:

In person