Referral Coordinator

Job in Fresno, Fresno County, California, 93650, USA

Listing for: Career Strategies

Full Time position
Listed on 2025-12-24

Job specializations:

Healthcare
Medical Billing and Coding, Healthcare Administration

Salary/Wage Range or Industry Benchmark: 40000 - 70000 USD Yearly USD 40000.00 70000.00 YEAR

Job Responsibilities

Prior authorization submission: Prepare and submit prior authorization requests to insurance companies, including necessary medical documentation, diagnosis codes, and treatment plans.

Clinical review: Analyze medical records to determine if a requested service or medication aligns with medical necessity guidelines and insurance coverage.

Communication with providers: Contact healthcare providers to gather additional information or clarify details regarding requested services for prior authorization.

Follow-up with insurance companies: Monitor the status of pending prior authorization requests and follow up with insurance companies to obtain timely approvals.

Patient education: Explain the prior authorization process to patients, including potential delays and necessary documentation.

Documentation: Maintain accurate records of all prior authorization requests, including patient information, insurance details, and approval status.

Billing support: Collaborate with billing staff to identify and resolve potential billing issues related to prior authorization.

Insurance verification: Accurately verify patient insurance information, including eligibility, benefits, and coverage details.

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