Job Title: Prior Authorization, Referral, and Medical Records Coordinator Department: Clinic Ops
About the Role: The Referrals, Prior Authorizations, and Medical Records Coordinator is responsible for ensuring the timely and accurate submission, follow-up, and approval of referrals and prior authorizations. This role requires a strong sense of urgency, attention to detail, and consistent, high-quality communication with patients, providers, and insurance companies. The coordinator plays a key role in supporting continuity of care by ensuring all required documentation is complete and processed efficiently.
What You"ll Do:
Ensure timely, accurate submission, follow-up, and approval of referrals, prior authorizations, and medical records while maintaining a high level of urgency and quality. Communicate effectively with patients, insurance companies, and internal teams regarding authorization status, requirements, and updates. Review requests for accuracy and completeness, ensuring all required information and supporting documentation are included prior to submission. Assist with gathering and submitting medical necessity documentation to expedite approvals and ensure compliance with payer requirements. Perform consistent and appropriate follow-up on all pending authorizations and referrals. Collaborate with clinical and administrative departments to obtain required information for prior authorizations and to support appeals when necessary. Document all interactions with insurance companies and/or patients accurately and thoroughly in the system. Maintain detailed and accurate records of all prior authorization information, including approval dates, billing units, procedure codes, and authorization numbers within the patient profile. Proactively monitor and manage prior authorizations approaching expiration and initiate renewal processes as needed. Ensure all medical records requests are processed accurately and in compliance with organizational policies and regulatory standards. Complete all assigned duties, projects, and reports in a timely manner on a daily, weekly, or monthly basis as directed by leadership.
Qualifications:
High school diploma or equivalent required. Minimum of __1___ year experience in prior authorization, referrals, clinical operations, or related functions Strong verbal and written communication skills; must be able to communicate in a professional and courteous manner. Proficient in Microsoft Office applications and insurance eligibility database. Excellent data entry and typing skills.
You"re great for this role if:
Knowledge of managed care and medical insurance plans Knowledge of Elation EHR or similar system Experience with medications, injections, biologics, and specialty treatment authorizations