We are seeking an experienced
Prior Authorization & Referral Coordinator to join our growing orthopedic practice. The ideal candidate will have a strong background in insurance authorizations, referral coordination, and EMR management, with hands-on experience using
AdvancedMD. Previous orthopedic practice experience is required, and pain management experience is highly preferred.
This role is essential to ensuring patients receive timely access to orthopedic care by coordinating authorizations, referrals, and payer requirements while maintaining accurate documentation and communication with providers, patients, insurance carriers, and referring offices.
Key Responsibilities
- Obtain prior authorizations for orthopedic surgeries, procedures, imaging studies, injections, medications, durable medical equipment (DME), and specialty services.
- Process and coordinate incoming and outgoing patient referrals.
- Verify insurance eligibility, benefits, and authorization requirements.
- Submit complete and accurate clinical documentation to insurance carriers and third-party payers.
- Monitor authorization status and proactively follow up to avoid delays in patient care.
- Collaborate with physicians and clinical staff to obtain supporting medical records and documentation.
- Maintain accurate authorization and referral records within AdvancedMD EMR.
- Communicate authorization approvals, denials, and referral updates to providers, patients, and referring physician offices.
- Resolve authorization denials by gathering additional documentation and initiating reconsideration or appeal requests when appropriate.
- Ensure compliance with payer guidelines, regulatory requirements, and practice workflows.
- Assist with procedure and surgery scheduling once authorizations have been approved.
- Manage multiple payer requirements and deadlines while maintaining productivity and accuracy.
- Support continuous workflow improvement and efficient referral management processes.
Qualifications
- Minimum 2 years of experience in prior authorization and referral coordination within a medical practice.
- Hands-on experience using AdvancedMD EMR.
- Previous experience supporting an orthopedic practice.
- Strong knowledge of commercial insurance, Medicare, Medicaid, workers compensation, and managed care plans.
- Experience obtaining authorizations for surgeries, imaging, procedures, injections, and specialty medications.
- Strong understanding of medical terminology and orthopedic procedures.
- Excellent organizational skills and attention to detail.
- Strong written and verbal communication skills.
- Ability to prioritize and manage a high-volume workload in a fast-paced environment.
- Proficient in Microsoft Office and standard medical office software.
- Experience supporting pain management providers.
- Familiarity with orthopedic and pain management coding, procedures, and payer requirements.
- Experience working in a multi-specialty physician group.
- Bilingual in English and Spanish is a plus.
Perks
- Permanent Work From Home
- Leave Credits
- Monetary Allowance
- Annual Bonus
- Weekly Paychecks
- Fixed Weekends Off
- Thriving Company Culture with Complete Autonomy
- Exclusive Specialized Training Programs
- Unlock Your Potential with a Highly Competitive Salary
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