Job Overview:

We are seeking a highly organized, detail-oriented, and proactive Prior Authorization & PCP Referral Coordinator to join our healthcare operations team. This role is responsible for managing all prior authorizations and Primary Care Physician (PCP) referrals throughout the business day to ensure patients receive timely care while minimizing treatment delays.

The ideal candidate has experience working with U.S. healthcare insurance, prior authorization processes, and referral management. They possess strong organizational skills, excellent attention to detail, and the ability to prioritize multiple requests in a fast-paced medical environment.

Schedule: Remote, Full-Time | Monday through Friday during EST Business hours. 

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.

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.
• 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:

• Health Insurance
• Immediate hiring
• Permanent work from home

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.

Important Disclaimer:

• BruntWork never charges fees for applying or any part of the hiring process—it is 100% free. If you are ever asked for payment, please stop and report it immediately through the ‘Contact Us’ form on our official BruntWork website.