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
Similar Jobs
Fintech • Information Technology • Insurance • Financial Services • Big Data Analytics
Handle inbound customer inquiries by phone and email for group disability claims, research policy/claim questions, process transactions, escalate as needed, and deliver empathetic, high-quality service while using multiple internal systems and attending in-person training.
Fintech • Information Technology • Insurance • Financial Services • Big Data Analytics
Supervise and coach a team of customer care associates to deliver excellent service on MetLife products. Monitor calls, provide feedback, create performance appraisals, ensure regulatory compliance (ERISA, HIPAA), partner with recruiting, and foster engagement and cross-team collaboration to meet business metrics.
Top Skills:
ExcelMS OfficeMicrosoft Word
eCommerce • Legal Tech • Professional Services • Software • Data Privacy
Manage a portfolio of established customer accounts via inbound and outbound calls, uncover upsell and retention opportunities, meet sales and retention targets, monitor purchasing patterns, perform follow-up outreach, and build long-term customer relationships in a metrics-driven environment.
What you need to know about the Charlotte Tech Scene
Ranked among the hottest tech cities in 2024 by CompTIA, Charlotte is quickly cementing its place as a major U.S. tech hub. Home to more than 90,000 tech workers, the city’s ecosystem is primed for continued growth, fueled by billions in annual funding from heavyweights like Microsoft and RevTech Labs, which has created thousands of fintech jobs and made the city a go-to for tech pros looking for their next big opportunity.
Key Facts About Charlotte Tech
- Number of Tech Workers: 90,859; 6.5% of overall workforce (2024 CompTIA survey)
- Major Tech Employers: Lowe’s, Bank of America, TIAA, Microsoft, Honeywell
- Key Industries: Fintech, artificial intelligence, cybersecurity, cloud computing, e-commerce
- Funding Landscape: $3.1 billion in venture capital funding in 2024 (CED)
- Notable Investors: Microsoft, Google, Falfurrias Management Partners, RevTech Labs Foundation
- Research Centers and Universities: University of North Carolina at Charlotte, Northeastern University, North Carolina Research Campus
