Medication Prior Authorization and Referral Coordinator

Location: Remote (Work From Home)

Employment Type: Full-Time - Graveyard Shift

Department: Authorization & Referrals

We are seeking a highly organized and experienced Medication Prior Authorization & Referral Coordinator to join our growing multi-specialty healthcare team. This role is ideal for a healthcare professional with a strong clinical background and hands-on experience managing medication prior authorizations, insurance coordination, and patient referrals.

As a key member of our Authorization & Referrals Department, you will work closely with providers, pharmacies, insurance companies, and patients to ensure timely access to prescribed medications and healthcare services.

Medication Prior Authorizations

• Submit and manage medication prior authorization requests through CoverMyMeds, insurance portals, and related systems.
• Review medications, ICD-10 codes, clinical documentation, and payer requirements.
• Obtain supporting clinical information from providers to facilitate approvals.
• Monitor pending authorizations and proactively follow up with insurance carriers.
• Coordinate appeals and alternative medication requests for denied authorizations.
• Maintain accurate documentation of authorization outcomes and follow-up activities.

Referrals & Care Coordination

• Process referrals and coordinate services with specialists and healthcare providers.
• Ensure all referral documentation is complete and compliant with insurance guidelines.
• Track referral statuses and address delays that may impact patient care.

Communication & Documentation

• Serve as the primary point of contact for medication authorization inquiries.
• Provide timely updates to patients, providers, and pharmacies.
• Maintain accurate records within the EMR system.
• Collaborate with clinical and administrative teams across multiple locations.
• Ensure HIPAA compliance and adherence to organizational policies.
  

Preferred

Registered Pharmacist (RPh)

Licensed Practical Nurse (LPN)

Registered Nurse (RN)

Certified Medical Assistant (CMA/RMA)

Experience

• 1-2+ years of experience in medication prior authorizations, referrals, or insurance coordination.
• Experience in a multi-specialty medical practice, primary care setting, or healthcare authorization department.

Strong knowledge of:

• Medication terminology
• ICD-10 coding
• Medical necessity documentation
• Insurance authorization requirements
• Medicare, Medicaid, Medicare Advantage, and Commercial Plans

Technical Skills

• Experience with:
• CoverMyMeds
• Availity
• AdvancedMD
• Insurance carrier portals
• Electronic Medical Records (EMR)
• Microsoft Office Suite

Additional Qualifications

• Strong organizational and multitasking skills.
• Excellent attention to detail.
• Ability to prioritize urgent patient requests in a high-volume environment.
• Effective communication and problem-solving abilities.
• Ability to work independently while collaborating across departments.
• Spanish-English bilingual skills are highly preferred.

Candidates must be based in Metro Manila, Philippines or neighboring cities

Strictly for candidates currently based in the Philippines and legally authorized to work in the Philippines.

Applications from candidates outside the Philippines will not be acknowledged or considered.

Apply now or send your CV to [Confidential Information] / You can also send me a message! :