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
Cloud • Fintech • Software • Business Intelligence • Consulting • Financial Services
Manage tax compliance and advisory work, review tax returns, build client relationships, train staff, and participate in business development.
Top Skills:
AccountingBusiness DevelopmentCpaTax AdvisoryTax Compliance
Cloud • Fintech • Software • Business Intelligence • Consulting • Financial Services
The Senior Consultant will lead healthcare consulting projects, analyze market and financial data, develop client presentations, and mentor junior team members.
Top Skills:
ExcelFinancial Modeling
Cloud • Fintech • Software • Business Intelligence • Consulting • Financial Services
The role involves providing financial management support to healthcare clients, executing accounting functions, analyzing financial data, and enhancing client operations through process improvements.
Top Skills:
Accounting SystemsFinancial Reporting SoftwareHealthcare-Specific Technologies
What you need to know about the NYC Tech Scene
As the undisputed financial capital of the world, New York City is an epicenter of startup funding activity. The city has a thriving fintech scene and is a major player in verticals ranging from AI to biotech, cybersecurity and digital media. It also has universities like NYU, Columbia and Cornell Tech attracting students and researchers from across the globe, providing the ecosystem with a constant influx of world-class talent. And its East Coast location and three international airports make it a perfect spot for European companies establishing a foothold in the United States.
Key Facts About NYC Tech
- Number of Tech Workers: 549,200; 6% of overall workforce (2024 CompTIA survey)
- Major Tech Employers: Capgemini, Bloomberg, IBM, Spotify
- Key Industries: Artificial intelligence, Fintech
- Funding Landscape: $25.5 billion in venture capital funding in 2024 (Pitchbook)
- Notable Investors: Greycroft, Thrive Capital, Union Square Ventures, FirstMark Capital, Tiger Global Management, Tribeca Venture Partners, Insight Partners, Two Sigma Ventures
- Research Centers and Universities: Columbia University, New York University, Fordham University, CUNY, AI Now Institute, Flatiron Institute, C.N. Yang Institute for Theoretical Physics, NASA Space Radiation Laboratory
