Job Description: Prior Authorization & Referral Coordinator
Position Overview:
OPN is seeking a highly organized and proactive Prior Authorization & Referral Coordinator to join our clinical and care coordination teams. The ideal candidate will play a critical role in ensuring seamless and compliant authorization and referral processes, contributing to optimized patient care and operational efficiency. This position requires strong attention to detail, excellent communication skills, and a collaborative approach to problem-solving.
Essential Duties and Responsibilities:
- Prior Authorization Management: Accurately submit prior authorization requests for medical procedures, treatments, and medications to insurance payers, ensuring compliance with payer guidelines.
- Tracking & Reporting: Maintain and update authorization tracking systems, including data entry, status updates, and generating reports for internal use.
- Referral Coordination: Manage detailed records of referrals and authorizations, ensuring timely communication with providers and internal teams.
- Documentation Updates: Update patient records with authorization statuses, referral details, and other relevant information in the Electronic Health Record (EHR) system.
- Insurance Verification: Determine the need for prior authorization based on insurance guidelines and verify patient eligibility.
- Medical Records Review: Compile necessary medical documentation for prior authorization submissions while adhering to HIPAA regulations.
- Compliance Assurance: Ensure adherence to health plan policies, regulatory requirements, and organizational standards.
Education and Work Experience Requirements:
- Minimum of 2 years of experience in prior authorization or referral coordination.
- High school diploma or equivalent; additional certifications in healthcare administration or related fields preferred.
- Oncology experience is a plus but not required.
- Proven ability to work independently while managing multiple tasks efficiently within deadlines.
Skills & Competencies:
- Exceptional organizational skills with keen attention to detail.
- Strong verbal and written communication skills for effective collaboration with internal teams and external stakeholders.
- Proficiency in Microsoft Office Suite (Excel, Word) and familiarity with EHR systems.
- Analytical problem-solving capabilities to address administrative challenges efficiently.
- Ability to maintain confidentiality when handling sensitive patient information.
Physical Requirements:
- Ability to perform job functions safely and effectively in compliance with ADA standards.
- Regular attendance and punctuality are essential for this role.
- Must be able to communicate clearly via telephone and other communication tools.
Why Join OPN?
This position offers the opportunity to make a meaningful impact on patient care by ensuring timely access to necessary medical services. If you thrive in a fast-paced healthcare environment that values precision, teamwork, and patient-centered care, we encourage you to apply
Job Type: Full-time
Pay: $18.00 - $22.00 per hour
Expected hours: 40 per week
Benefits:
- 401(k) matching
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance
Ability to Commute:
- Glendale, CA 91203 (Required)
Ability to Relocate:
- Glendale, CA 91203: Relocate before starting work (Required)
Work Location: In person
