The Pre-Authorization & Referral Coordinator verifies insurance coverage, manages prior authorizations, processes referrals, and ensures compliance with U.S. healthcare systems.
This is a remote position.
Only LATAM-based candidates (bilingual in Spanish and English)
We are hiring an experienced Pre-Authorization & Referral Coordinator to support a fast-paced U.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 an Independent Contractor opportunity.
Key Responsibilities
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 an Independent Contractor opportunity.
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
Requirements
- 2+ years of experience in a U.S. medical office handling insurance verification and prior authorizations
- Proven hands-on experience obtaining authorizations independently (not only assisting)
- Strong knowledge of Medicare, Medicaid, and commercial plans (HMO, PPO, POS)
- Solid understanding of deductibles, copays, coinsurance, and out-of-pocket maximums
- Working knowledge of ICD-10 and CPT codes
- Experience using payer portals (Availity, UnitedHealthcare, Aetna, Cigna, etc.)
- Experience working with EMR/EHR systems
- High attention to detail and ability to manage high-volume workflows
- Strong English communication skills (written and verbal)
- Reliable high-speed internet connection (minimum 100 MB)
- Own laptop or desktop and professional headset
Benefits
- 100% Remote position
- Full-time schedule (Monday–Friday)
- Weekends off
- Performance-based bonuses
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