Referral Coordinator

Responsibilities

• Process and submit prior authorizations accurately and in a timely manner to ensure patients receive necessary services without delays.
• Review patient and insurance information to verify completeness and correctness before submitting prior authorization requests.
• Utilize IPA portals and other insurance platforms to enter, track, and update prior authorization requests and related documentation.
• Communicate directly with specialists to gather required clinical information, clarify requests, and coordinate care needs.
• Support family practice providers and staff by managing authorization workflows and addressing questions related to insurance approvals.
• Notify patients of their authorization status, including approvals, denials, or requests for additional information, in a clear and respectful manner.
• Document all interactions and updates related to prior authorizations, specialist communications, and patient notifications in the appropriate systems.
• Accurately data entry of patient, insurance, and clinical information to maintain up-to-date and organized records.
• Collaborate with healthcare team members to resolve issues related to insurance coverage, prior authorizations, and access to care.
• Provide bilingual support in Spanish and English when communicating with patients, specialists, and other healthcare professionals.

Essential Skills

• Experience processing and submitting prior authorizations in a healthcare or medical setting.
• Proficiency in data entry with strong attention to detail and accuracy.
• Knowledge of healthcare and medical office processes, including working with insurance-related documentation.
• Ability to work with IPA portals and other insurance or provider platforms to manage prior authorizations.
• Strong communication skills for coordinating with specialists, family practice providers, and patients.
• Ability to clearly explain authorization status and next steps to patients.
• Bilingual fluency in Spanish and English.

Additional Skills & Qualifications

• Previous experience in a healthcare support, patient coordinator, or medical office role.
• Familiarity with insurance terminology, benefits, and authorization requirements.
• Ability to manage multiple tasks and authorization requests simultaneously while meeting deadlines.
• Strong organizational skills and the ability to maintain accurate records.
• Customer service mindset with a focus on supporting patients and clinical teams.